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(Stroke. 1999;30:2167-2173.)
© 1999 American Heart Association, Inc.

Original Contributions

Neuropsychological Impairment in Stroke, Carotid Stenosis, and Peripheral Vascular Disease

A Comparison With Healthy Community Residents

Rahul Rao, MRCPsych; Steven Jackson, MD Robert Howard, MD

From the Department of Old Age Psychiatry, Maudsley Hospital (R.R.) and Institute of Psychiatry (R.R., R.H.), and Department of Health Care of the Elderly, King's College School of Medicine and Dentistry, Dulwich Hospital (S.J.), London, UK.

Correspondence to Dr Rahul Rao, Department of Old Age Psychiatry, Job Ward, Thomas Guy House, Guy's Hospital, London SE1 9RT, UK. E-mail rrao{at}globalnet.co.uk

Background and Purpose—An increasing body of literature suggests a role for clinically "silent" cerebrovascular disease in the pathogenesis of cognitive impairment. Such pathology commonly occurs in the absence of stroke. The main aim of the study was to examine neuropsychological impairment associated with cerebrovascular and peripheral vascular disease (PVD) and to compare cognitive deficits with a nonvascular control group. The main hypothesis was that older people with both transient ischemic attack (TIA) and PVD would demonstrate greater cognitive impairment than controls.

Methods—A battery of neuropsychological tests was administered to 4 groups of community residents older than 65 years. The groups comprised 25 patients with carotid stenosis and TIA, 25 nonamputees with PVD, 25 patients with stroke, and 25 matched (with the stroke group) controls.

Results—Stroke patients showed greater impairment than controls in all tests. PVD patients did not perform significantly worse (P<0.05 after Bonferroni correction) than control subjects on any of the neuropsychological tests. However, 25% of PVD patients had scores lying within the bottom 5% of control group scores for attention, calculation, and 1 test of frontal lobe function. TIA patients were more impaired in general intellectual impairment and frontal lobe function than controls. Frontal lobe impairment, suicidal thinking, and age were all independent predictors of global cognitive impairment in the TIA group. Frontal lobe impairment was the only predictor of global cognitive impairment in the PVD group.

Conclusions—TIA and PVD patients showed similar patterns of neuropsychological impairment, but TIA may result in more prolonged cognitive impairment, particularly in frontal lobe function. This group may be at increased risk of vascular dementia as well as impulsivity and suicide.

Key Words: cerebral ischemia, transient • cognition • frontal lobe • neuropsychological tests • peripheral vascular disease • suicide

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