无症状性颈动脉狭窄与认知功能障碍关系的研究进展

摘要

颈动脉狭窄是导致缺血性卒中的危险因素,当其表现为脑缺血及视网膜缺血等时,称为有症状性颈动脉狭窄,如果没有这些临床症状,则称之为无症状性颈动脉狭窄.无症状性颈动脉狭窄虽无临床症状,却会导致认知功能减退,而认知功能减退的最终结局是痴呆,因此,无症状性颈动脉狭窄不容小觑.本文总结近年来关于无症状性颈动脉狭窄与认知功能障碍的研究发现,无症状性颈动脉狭窄是认知功能下降的独立危险因素,其通过破坏脑连接网络、损伤白质及灰质微观结构、降低脑灌注及干扰大脑皮质电生理活动等机制导致认知功能障碍.因此,对无症状性颈动脉狭窄进行早期临床干预〔如颈动脉内膜剥脱术(CEA)及颈动脉内支架植入术(CAS)〕对于预防和治疗认知功能障碍具有重要意义.%Carotid artery stenosis is one of the risk factors for ischemic stroke.With symptoms such as cerebral and retinal ischemia,it is called symptomatic carotid artery stenosis,without these features,it is referred to as asymptomatic carotid artery stenosis.Asymptomatic carotid artery stenosis has no clinical symptoms,but it is associated with cognitive decline which may eventually result in dementia.Therefore,asymptomatic carotid artery stenosis should not be underestimated.In this paper,the recent progress in the study of asymptomatic carotid artery stenosis and cognitive impairment is summarized.The results show that asymptomatic carotid artery stenosis is an independent risk factor for cognitive decline,it can lead to cognitive impairment by destroying the brain connectivity network,damaging white matter and gray matter microstructure,reducing the cerebral perfusion and interfering with the electrophysiological activity of the cerebral cortex.Therefore,carrying out early clinical intervention,such as carotid endarterectomy(CEA) and carotid artery stenting(CAS),is of great significance for the prevention and treatment of cognitive impairment in patients with asymptomatic carotid artery stenosis.