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Carotid Disease and Cognitive Dysfunction

H.J.M. Barnett, CC, MD
[+] Article, Author, and Disclosure Information

From King City, Ontario L7B 1K4, Canada.

Potential Conflicts of Interest: None disclosed.

Requests for Single Reprints: H.J.M. Barnett, CC, MD, 14865, 7th Concession, King City, Ontario L7B 1K4, Canada; e-mail, hjmb@sympatico.ca.

Ann Intern Med. 2004;140(4):303-304. doi:10.7326/0003-4819-140-4-200402170-00013
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The introduction of cerebral angiography in the 1930s by Moniz, followed by detailed postmortem studies of the cervical portion of the carotid artery in the 1950s by Miller Fisher, drew attention to the extracranial carotid artery's being more important than the middle cerebral artery in ischemic stroke (1). The description of the diagnostic features of carotid disease soon followed, and this led to strategies for preventing or eliminating carotid lesions. From the earliest writings, clinical investigators have debated a possible connection between severe carotid disease and impaired cognition. Few dispute the relationship between cognitive decline and large areas of infarction of cortex supplied by the carotid artery. The unsettled component is the causal relationship between mild cognitive decline and asymptomatic disease in the carotid artery that supplies the dominant hemisphere (the left carotid in 98% of right-handed individuals). In the presence of intellectual changes, should an otherwise-asymptomatic person be called a symptomatic patient? Management could depend on the answer, and we will return to that subject at the end of this editorial.

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