Surface-based Cortical Morphometry, White Matter Hyperintensity, and Multidomain Cognitive Performance in Asymptomatic Carotid Stenosis

Carotid stenosis is a major contributor to vascular dementia. Recent studies suggest that even clinically asymptomatic carotid stenosis is linked with cognitive decline and neuroimaging changes. Here we examined surface-based cortical morphometry, white matter hyperintensity (WMH), and multidomain cognitive performance in unilateral severe (>70% narrowing) asymptomatic carotid stenosis (SACS). We included 24 SACS patients (19 males/5 females; 64.25 +/- 7.18 years) and 24 comorbidities-matched controls (19 males/5 females; 67. 16 +/- 6.10 years), and measured cortical thickness, sulcal depth, gyrification, cortical complexity, and WMH loads with structural MRI images. The SACS patients exhibited: (1) thinner cortex in bilateral somatosensory/motor, bilateral inferior frontal, bilateral fusiform, and left lateral temporal areas; (2) shallower sulci in left lateral temporal, parietal, insular and somatosensory/motor areas; (3) both hyper- and hypo-gyrification in lateral temporal and frontal cortices; (4) lower complexity (fractal dimension) in left insular and right superior temporal areas. Further association analyses showed that the cortical alterations were significantly correlated with verbal memory and WMH burden in SACS. These results suggest that SACS patients present a left-dominated damage tendency, especially in the Perisylvian cortices that span across several large-scale systems of somatosensory/motor and language. Our findings also provide cortical anatomy evidence for cognitive impairment in SACS, suggesting a neuroanatomical predisposition to dementia and cerebrovascular events. (c) 2021 IBRO. Published by Elsevier Ltd. All rights reserved.

Automated summary

Carotid stenosis, even when clinically asymptomatic, is associated with cognitive decline and neuroimaging changes. Patients with severe asymptomatic carotid stenosis exhibit thinner cortex, shallower sulci, abnormal gyrification, and lower complexity in specific brain regions, which are significantly correlated with verbal memory and WMH burden. These findings suggest a neuroanatomical predisposition to dementia and cerebrovascular events in patients with severe asymptomatic carotid stenosis.