The Barcelona-Asymptomatic Intracranial Atherosclerosis (AsIA) study: Subclinical cervico-cerebral stenosis and middle cerebral artery pulsatility index as predictors of long-term incident cognitive impairment

• Published in: Atherosclerosis Vol. 312; pp. 104 - 109
• Main Authors: Crespo-Cuevas, A.M., Canento, T., Hernández-Perez, M., Cáceres, C., González, A., Ispierto, L., Mataró, M., Vilas, D., Planas-Ballvé, A., Martin, L., Muñoz-Ortiz, L., Arenillas, J.F., Via, M., Castañón, M., Millan, M., Dorado, L., López-Cancio, E.
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.11.2020
• Subjects: Cognitive impairment; Dementia; Intracranial stenosis; Pulsatility index; Sublinical atherosclerosis; Sublinical atherosclerosis; Intracranial stenosis; Pulsatility index; Cognitive impairment; Dementia
• ISSN: 0021-9150; 1879-1484; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2020.08.025

We aimed to study subclinical non-invasive vascular markers as predictors of incident long-term cognitive impairment in a longitudinal population-based study. The Barcelona-Asymptomatic Intracranial Atherosclerosis (AsIA) study is a population-based study that included a random sample of 933 Caucasian subjects (mean age 66 years, 64% male) with a moderate-high vascular risk and without history of stroke or dementia. Subclinical carotid and intracranial stenosis was assessed at baseline visit by cervical and transcranial color-coded duplex (TCCD) and confirmed by magnetic resonance angiography. Cervico-cerebral stenosis (CCS) was defined as the presence of extra and/or intracranial stenosis >50%. Baseline middle cerebral artery pulsatility index (MCA-PI) was measured bilaterally by TCCD, and mean PI of both sides was considered for analyses. Subjects were followed-up to determine incident long-term cognitive impairment (mild cognitive impairment or dementia). After a median of 7.16 [6.91–7.75] years of follow-up, 91 subjects (9.7%) developed cognitive impairment, 27 of them mild cognitive impairment, and 64 dementia. Incidence of cognitive impairment was significantly higher among subjects with subclinical CCS (21.4% versus 9% in those without CCS) and among those with mean MCA-PI>1 (13.5% versus 7.4% in those with MCA-PI<1). In multivariate Cox regression analyses, both CCS and MCA-PI>1 were independently associated with incident cognitive impairment with HR of 2.07 [1.11–3.88] and 1.58 [1.02–2.46], respectively. Subclinical cervico-cerebral stenosis and higher MCA-PI are non-invasive neurosonological markers of incident long-term cognitive impairment in our population. [Display omitted] •We evaluated non-invasive sonographic predictors of incident cognitive decline.•Subclinical cervico-cerebral stenosis was a predictor of long-term cognitive decline.•Intracranial pulsatility index behaved as a predictor of cognitive impairment.