Association of subclinical carotid atherosclerosis with immediate memory and other cognitive functions

My right carotid artery is completely closed up and I don't think my cognitive functioning has slowed down one bit. 

Association of subclinical carotid atherosclerosis with immediate memory and other cognitive functions

Geriatrics and Gerontology International

Matsumoto L, et al.

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This study was meant to clarify if carotid atherosclerosis and its risk factors are associated with cognitive decline. Findings demonstrated that subclinical carotid atherosclerosis, defined as thickened intima-media thickness (IMT), could be a marker for early stages of cognitive impairment (CI), especially for immediate memory recall and the impairment was supposedly attributed to cerebral microvascular dysfunction in the frontal lobe.

Methods

• Researchers assessed 206 individuals who visited their center for health screening.
• They performed physical examinations, blood tests, intima–media thickness (IMT) measurement by carotid ultrasonography, brain magnetic resonance imaging scanning and cognitive function assessments.
• A total of 30 individuals, who had significant cerebrovascular lesions detected in magnetic resonance imaging scans, were excluded.(Cherry picking here, excluding the worst cases, like me)
• To detect early cognitive decline, researchers defined “cognitive impairment (CI)” when a patient satisfied at least one of three criteria.
• These were Mini–Mental State Examination score <24, clock–drawing test score <4 coexisting with forgetfulness and Wechsler Memory Scale–revised delayed recall score below the normal range for the duration of education (>16 years of education: ≥9, 10–15 years: ≥5, 0–9 years: ≥3).

Results

• Findings reported that among 176 individuals, 27 were placed in the CI group.
• Researchers observed that IMT was significantly higher in the CI group as compared with the non–CI group (mean ± SD: 2.0 ± 1.0 vs 1.7 ± 0.7, P = 0018 by Student's t–test).
• They also noted that other atherosclerotic risk factors, such as blood pressure, low–density lipoprotein cholesterol, and hemoglobin A1c, were not significantly different between the two groups.
• In multivariate analysis, it was highlighted that maximum IMT was associated with impaired immediate recall score on Wechsler Memory Scale–revised, independent of the presence of deep white matter hyperintensities on the magnetic resonance imaging scan.

Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation

So I'm now drinking cranberry-pomegranate juice instead of OJ. You doctor can do the hard work of contacting these researchers to see what the daily amounts were. Hell this is only 7 years old, is your doctor so fucking incompetent that they haven't come up with a dietary protocol for this yet? They'd rather just prescribe pills instead of solving the problem the correct way?

Cranberry juice consumption may protect against cardiovascular disease

Drinking low-calorie cranberry juice may help lower risk of heart disease, diabetes and stroke

 

Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation

Aviram M¹, Rosenblat M, Gaitini D, Nitecki S, Hoffman A, Dornfeld L, Volkova N, Presser D, Attias J, Liker H, Hayek T.

Author information

Erratum in

• Clin Nutr. 2008 Aug;27(4):671.

Abstract

Dietary supplementation with polyphenolic antioxidants to animals was shown to be associated with inhibition of LDL oxidation and macrophage foam cell formation, and attenuation of atherosclerosis development. We investigated the effects of pomegranate juice (PJ, which contains potent tannins and anthocyanins) consumption by atherosclerotic patients with carotid artery stenosis (CAS) on the progression of carotid lesions and changes in oxidative stress and blood pressure. Ten patients were supplemented with PJ for 1 year and five of them continued for up to 3 years. Blood samples were collected before treatment and during PJ consumption. In the control group that did not consume PJ, common carotid intima-media thickness (IMT) increased by 9% during 1 year, whereas, PJ consumption resulted in a significant IMT reduction, by up to 30%, after 1 year. The patients' serum paraoxonase 1 (PON 1) activity was increased by 83%, whereas serum LDL basal oxidative state and LDL susceptibility to copper ion-induced oxidation were both significantly reduced, by 90% and 59%, respectively, after 12 months of PJ consumption, compared to values obtained before PJ consumption. Furthermore, serum levels of antibodies against oxidized LDL were decreased by 19%, and in parallel serum total antioxidant status (TAS) was increased by 130% after 1 year of PJ consumption. Systolic blood pressure was reduced after 1 year of PJ consumption by 12% [corrected] and was not further reduced along 3 years of PJ consumption. For all studied parameters, the maximal effects were observed after 1 year of PJ consumption. Further consumption of PJ, for up to 3 years, had no additional beneficial effects on IMT and serum PON1 activity, whereas serum lipid peroxidation was further reduced by up to 16% after 3 years of PJ consumption. The results of the present study thus suggest that PJ consumption by patients with CAS decreases carotid IMT and systolic blood pressure and these effects could be related to the potent antioxidant characteristics of PJ polyphenols.

PMID:

15158307

[PubMed - indexed for MEDLINE]

Large-vessel correlates of cerebral small-vessel disease

Definitely a question for your doctor. How does knowing this prevent your next stroke?
http://www.docguide.com/large-vessel-correlates-cerebral-small-vessel-disease
OBJECTIVE: Our aim was to investigate the relationship of carotid structure and function with MRI markers of cerebral ischemic small-vessel disease. METHODS: The study comprised 1,800 participants (aged 72.5 ± 4.1 years, 59.4% women) from the 3C-Dijon Study, a population-based, prospective cohort study, who had undergone quantitative brain MRI and carotid ultrasound. We used multivariable logistic and linear regression adjusted for age, sex, and vascular risk factors. RESULTS: Presence of carotid plaque and increasing carotid lumen diameter (but not common carotid artery intima-media thickness) were associated with higher prevalence of lacunar infarcts: odds ratio (OR) = 1.60 (95% confidence interval [CI]: 1.09-2.35), p = 0.02 and OR = 1.24 (95% CI: 1.02-1.50), p = 0.03 (by SD increase). Carotid plaque was also associated with large white matter hyperintensity volume (WMHV) (age-specific top quartile of WMHV distribution): OR = 1.32 (95% CI: 1.04-1.67), p = 0.02, independently of vascular risk factors. Increasing Young elastic modulus and higher circumferential wall stress, reflecting augmented carotid stiffness, were associated with increasing WMHV (effect estimate [β]± standard error: 0.0003 ± 0.0001, p = 0.024; β ± standard error: 0.005 ± 0.002, p = 0.008). Large WMHV was also associated with increasing Young elastic modulus (OR = 1.22 [95% CI: 1.04-1.42], p = 0.01) and with decreasing distensibility coefficient (OR = 0.83 [95% CI: 0.69-0.99], p = 0.04), independently of vascular risk factors. Associations of carotid lumen diameter with lacunar infarcts and of carotid stiffness markers with WMHV were independent of carotid plaque. CONCLUSIONS: In addition to and independently of carotid plaque, increasing carotid lumen diameter and markers of carotid stiffness were associated with increasing prevalence of lacunar infarcts and increasing WMHV, respectively.

No added value of CIMT in predicting stroke, MI risk

This is not the rehab CIMT.   The important 4 paragraphs are here, so ask your doctor about your risk.
http://www.theheart.org/article/1436919.do
Common carotid intima-media thickness (CIMT) measurement does not add clinically meaningful information to the Framingham risk score for predicting a person's 10-year risk of first MI or stroke, according to a meta-analysis of relevant studies [1].

"Our results suggest that common CIMT measurements should not routinely be performed in the general population, as the overall added value may be too limited to result in health benefits," the authors say.

"This will come as a surprise for a number of physicians: those who have applied the common CIMT measurement in their routine clinical practice and seen potential benefit," senior author Dr Michiel L Bots (University Medical Center Utrecht, the Netherlands) said in an interview. "Our findings, however, indicate that, on average, common CIMT does not help risk stratification when information of established risk factors is already available."

The study was published in the August 22, 2012 issue of the Journal of the American Medical Association.

Carotid Test Boosts Cardiac Risk Prediction

I bet this test could have predicted my event. I wonder where the recommendation will be published. and how will they make sure both my doctor and my Dads' doctor will understand and recognize that doing this can prevent strokes.  Do you really think your doctor will know what to do?
http://www.medpagetoday.com/MeetingCoverage/AdditionalMeetings/32175
Determining one's vascular age via an ultrasound of the carotid intima-media thickness (CIMT) can help triage the so-called "worried well," a small study found.
In an effort to test the robustness of CIMT-adjusted risk, Lori Neri, CRNP, CLS, and colleagues from The Heart Care Group in Allentown, Pa., assessed the carotids of 26 patients with a first-time ST elevation myocardial infarction (STEMI) and no known prior cardiovascular disease.
They found that the CIMT-adjusted vascular age was significantly higher than the chronological age (79.5 versus 52.8 years, P<0.001).
In addition, although the Framingham risk score put 7.7% of these patients into a high-risk category, when the CIMT-adjusted age was added, 42.3% were classified as high-risk, Neri reported at the Preventive Cardiovascular Nurses Association meeting in National Harbor, Md.
STEMI patients are typically in their early 50s, generally younger than those with acute coronary syndromes, and they may not appear as obvious candidates to be at risk for heart disease.
"That's why it's important to find a way to identify those whose Framingham score does not categorize them as high risk but who in fact may have an elevated risk," Neri told MedPage Today.
The American Heart Association/American College of Cardiology guidelines say it's reasonable to use CIMT assessment in asymptomatic adults at intermediate risk (class IIa, level of evidence B).
The guidelines state that CIMT has been independently associated with future risk for ischemic events in middle-age individuals and that the risk is linearly associated with the artery thickness.
Neri, who is the director for the Center of Cardiac Risk Prevention at The Heart Care Group, said she gets a "fair amount of the worried well" in the clinic. These are people in their 50s with a strong family history of heart disease who are concerned about their own risk.
These people always undergo the usual risk assessment tests. If there is something that stands out, such as an abnormally high cholesterol, Neri will recommend the CIMT scan.
Co-author Martin E. Matsumura, MD, had previously shown that the Framingham risk score misses about 60% of patients presenting with a first STEMI. In this group, Matsumura said, the Framingham score "overemphasizes age as a risk factor."
The CIMT test uses an ultrasound probe to image the inner lining of the carotid arteries for subclinical plaque. Software calculates the vascular age based on the thickness of the lining.
"It's a sensitive and reproducible test," Neri said, adding that operator experience is crucial to obtaining high-quality results.
Insurance does not cover the test, but patients can have it done at Neri's clinic for under $50. "We started out charging $199, but continually dropped the price because we feel strongly about it's use and importance," Neri said.
She estimated that three out of every 10 people who get the test will have a vascular age that is higher than their chronological age. These people are then treated aggressively for preventive care.
For the study, Neri and colleagues assessed the carotid arteries of 26 patients within 30 days of admission for a first-time STEMI. Patients had no prior history of coronary artery disease, diabetes, peripheral, or cerebrovascular disease.
Researchers defined a vascular age for each patient based on an algorithm derived from the Atherosclerosis Risk in the Communities (ARIC) database and then re-calculated the Framingham risk score with the addition of the vascular age.
While the mean patient age was 52, the mean vascular age was nearly 80. Using the Framingham risk score, only two out of the 26 patients were considered at high risk for a heart attack. Adding the CIMT assessment boosted that number to 11. Neri said they are still analyzing the data to determine what other factors might help identify the remaining nine patients who had a STEMI.
The cohort as a whole had a mean 10% risk of a heart attack based on the Framingham score, which increased to 17% with the addition of the CIMT assessment.
"Our results suggest that a CIMT assessment may help improve risk stratifying in asymptomatic patients with a strong family history of heart disease and one or two risk factors," Neri concluded.
She added that patients who see they have an older vascular age are often much more motivated to change their lifestyle and comply with medication adherence.