Journal article
Cerebral hemodynamics and cognitive impairment: Baseline data from the RECON trial
Neurology, Vol.78(4), pp.250-255
2012
DOI: 10.1212/WNL.0b013e31824365d3
PMCID: PMC3280055
PMID: 22238418
Abstract
Objective: To determine whether unihemispheral hemodynamic failure is independently associated with cognitive impairment among participants in the National Institute of Neurological Disorders and Stroke-sponsored, multicenter, randomized clinical trial, Randomized Evaluation of Carotid Occlusion and Neurocognition (RECON).
Methods: Forty-three patients were randomized into RECON after recent symptomatic carotid artery occlusion and asymmetrically increased oxygen extraction fraction (OEF) by PET (OEF ratio >1.13), indicating stage II hemodynamic failure on the side of occlusion. The PET-positive patients were compared with 28 RECON-enrolled patients who met all clinical and radiographic inclusion/exclusion criteria but had no OEF asymmetry. A multivariable regression compared patients with PET OEF >1.13 or ≤1.13, stratifying by TIA vs. stroke as the qualifying event. The dependent variable was a composite neurocognitive score derived from averaging age-normalized z scores on a test battery that included global and internal carotid artery (ICA) side-relevant hemisphere-specific tests.
Results: There were no differences in demographic, clinical, or radiologic characteristics between the PET-positive and PET-negative patients except for PET OEF asymmetry. The unadjusted average neurocognitive z score was -1.45 for the PET-positive and -1.25 for the PET-negative patients, indicating cognitive impairment in both groups but no difference between them (p = 0.641). After adjustment for age, education, side of occlusion, depression, and previous stroke, there was a significant difference between PET-positive and PET-negative patients among those with TIA as a qualifying event (average z score = -1.41 vs. -0.76, p = 0.040). Older age and right ICA side were also significant in this model.
Conclusion: Hemodynamic failure is independently associated with cognitive impairment in patients with carotid occlusion. This finding establishes the physiologic parameter upon which the extracranial-intracranial bypass will be tested.
Details
- Title: Subtitle
- Cerebral hemodynamics and cognitive impairment: Baseline data from the RECON trial
- Creators
- R. S MARSHALL - Columbia University Medical Center, New York, NY, United StatesJ. R FESTA - Columbia University Medical Center, New York, NY, United StatesW. J POWERS - University of North Carolina at Chapel Hill, Chapel Hill, United StatesR. M LAZAR - Columbia University Medical Center, New York, NY, United StatesY. K CHEUNG - Columbia University Medical Center, New York, NY, United StatesR CHEN - Columbia University Medical Center, New York, NY, United StatesM. A PAVOL - Columbia University Medical Center, New York, NY, United StatesC. P DERDEYN - Washington University, St. Louis, MO, United StatesW. R CLARKE - University of Iowa, Ames, United StatesT. O VIDEEN - Washington University, St. Louis, MO, United StatesR. L GRUBB - Washington University, St. Louis, MO, United StatesH. P ADAMS - University of Iowa, Ames, United States
- Resource Type
- Journal article
- Publication Details
- Neurology, Vol.78(4), pp.250-255
- DOI
- 10.1212/WNL.0b013e31824365d3
- PMID
- 22238418
- PMCID
- PMC3280055
- NLM abbreviation
- Neurology
- ISSN
- 0028-3878
- eISSN
- 1526-632X
- Publisher
- Lippincott Williams & Wilkins; Hagerstown, MD
- Language
- English
- Date published
- 2012
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984020784602771
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