Asymptomatic carotid stenosis is associated with mobility and cognitive dysfunction and heightens falls in older adults.
Accidental Falls
Age Factors
Aged
Aged, 80 and over
Asymptomatic Diseases
Carotid Stenosis
/ complications
Cognition
Cognitive Dysfunction
/ diagnosis
Female
Humans
Male
Mobility Limitation
Postural Balance
Prognosis
Prospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Asymptomatic carotid artery stenosis
Balance
Cognition
Falls
Physical function
Journal
Journal of vascular surgery
ISSN: 1097-6809
Titre abrégé: J Vasc Surg
Pays: United States
ID NLM: 8407742
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
08
03
2019
accepted:
02
09
2019
pubmed:
9
11
2019
medline:
3
11
2020
entrez:
9
11
2019
Statut:
ppublish
Résumé
Atherosclerosis of the carotid bifurcation with plaque formation causes asymptomatic carotid artery stenosis (ACAS), which may also be associated with cerebral hypoperfusion. Cerebral hypoperfusion adversely affects multiple aspects of mobility and cognition. This study tests the hypothesis that community-dwelling older adults with a 50% or greater diameter-reducing ACAS will have mobility and cognitive impairments that heighten their risk for falls. Eighty community-dwelling adults completed a mobility assessment (Short Physical Performance Battery, Berg Balance Scale, Four Square Step Test, Dynamic Gait Index, Timed Up and Go, and gait speed), self-reported physical function (Activities-Specific Balance Confidence, SF-12 Physical Function Component), and cognitive tests (Mini-Mental State Examination). Falls were recorded for the past 6 months. Standardized carotid ultrasound examination classified participants into no stenosis (<50% diameter reduction) (n = 54), moderate stenosis (50%-69%) (n = 17), and high-grade stenosis (70%-99%) (n = 9) groups. Linear and logistic regression analyses determined the associations between these measures and the degree of stenosis (three groups). Logistic regression analysis showed their degree of stenosis was associated with reductions in mobility (Short Physical Performance Battery [P = .008], Berg Balance Scale [P = .0008], Four Square Step Test [P = .005], DGI [P = .0001], TUG [P = .0004], gait speed [P = .02]), perceived physical function (ABC [P < .0001], SF-12 Physical Function Component [P < .0001]), and cognition (MMSE [P = .003]). Adults with moderate- and high-grade stenosis had a greater incidence of falls compared with those without stenosis (relative risk, 2.86; P = .01). Results remained unchanged after adjustment for age, sex and cardiovascular risk factors. ACAS is associated with impaired mobility and cognition that are accompanied with increased fall risk. These impairments increased with worsening severity.
Sections du résumé
BACKGROUND
Atherosclerosis of the carotid bifurcation with plaque formation causes asymptomatic carotid artery stenosis (ACAS), which may also be associated with cerebral hypoperfusion. Cerebral hypoperfusion adversely affects multiple aspects of mobility and cognition. This study tests the hypothesis that community-dwelling older adults with a 50% or greater diameter-reducing ACAS will have mobility and cognitive impairments that heighten their risk for falls.
METHODS
Eighty community-dwelling adults completed a mobility assessment (Short Physical Performance Battery, Berg Balance Scale, Four Square Step Test, Dynamic Gait Index, Timed Up and Go, and gait speed), self-reported physical function (Activities-Specific Balance Confidence, SF-12 Physical Function Component), and cognitive tests (Mini-Mental State Examination). Falls were recorded for the past 6 months. Standardized carotid ultrasound examination classified participants into no stenosis (<50% diameter reduction) (n = 54), moderate stenosis (50%-69%) (n = 17), and high-grade stenosis (70%-99%) (n = 9) groups. Linear and logistic regression analyses determined the associations between these measures and the degree of stenosis (three groups).
RESULTS
Logistic regression analysis showed their degree of stenosis was associated with reductions in mobility (Short Physical Performance Battery [P = .008], Berg Balance Scale [P = .0008], Four Square Step Test [P = .005], DGI [P = .0001], TUG [P = .0004], gait speed [P = .02]), perceived physical function (ABC [P < .0001], SF-12 Physical Function Component [P < .0001]), and cognition (MMSE [P = .003]). Adults with moderate- and high-grade stenosis had a greater incidence of falls compared with those without stenosis (relative risk, 2.86; P = .01). Results remained unchanged after adjustment for age, sex and cardiovascular risk factors.
CONCLUSIONS
ACAS is associated with impaired mobility and cognition that are accompanied with increased fall risk. These impairments increased with worsening severity.
Identifiants
pubmed: 31699511
pii: S0741-5214(19)32320-1
doi: 10.1016/j.jvs.2019.09.020
pmc: PMC7196504
mid: NIHMS1068787
pii:
doi:
Types de publication
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1930-1937Subventions
Organisme : NIA NIH HHS
ID : P30 AG028747
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG033607
Pays : United States
Organisme : NINDS NIH HHS
ID : U01 NS080168
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
Références
J Gerontol A Biol Sci Med Sci. 2000 Apr;55(4):M221-31
pubmed: 10811152
J Gerontol A Biol Sci Med Sci. 2013 Apr;68(4):412-8
pubmed: 22987797
J Clin Epidemiol. 2001 Aug;54(8):837-44
pubmed: 11470394
Arch Phys Med Rehabil. 2017 Oct;98(10):1955-1961
pubmed: 28610969
Phys Ther. 2006 Apr;86(4):541-8
pubmed: 16579670
J Gerontol. 1994 Mar;49(2):M85-94
pubmed: 8126356
Neurology. 2012 Jan 24;78(4):250-5
pubmed: 22238418
Front Aging Neurosci. 2014 Jun 26;6:135
pubmed: 25018729
J Sports Med Phys Fitness. 1999 Dec;39(4):336-40
pubmed: 10726435
Exp Brain Res. 2005 Aug;164(4):541-8
pubmed: 15864565
Ann Intern Med. 2004 Feb 17;140(4):237-47
pubmed: 14970146
J Vasc Surg. 2011 Sep;54(3):e1-31
pubmed: 21889701
JAMA. 1995 May 10;273(18):1421-8
pubmed: 7723155
J Neurol. 2010 Jun;257(6):982-91
pubmed: 20099067
Neurobiol Aging. 2017 Sep;57:153-161
pubmed: 28648916
Exp Brain Res. 2014 Feb;232(2):515-25
pubmed: 24240389
J Gerontol A Biol Sci Med Sci. 2016 Aug;71(8):1081-8
pubmed: 26946101
J Am Geriatr Soc. 2002 Dec;50(12):1978-86
pubmed: 12473009
J Gerontol A Biol Sci Med Sci. 2004 Mar;59(3):242-8
pubmed: 15031308
Front Aging Neurosci. 2016 Apr 12;8:66
pubmed: 27148041
J Am Geriatr Soc. 1991 Feb;39(2):142-8
pubmed: 1991946
Eur Heart J. 2016 Aug 1;37(29):2315-2381
pubmed: 27222591
J Gerontol A Biol Sci Med Sci. 2018 Jul 9;73(8):1078-1082
pubmed: 29394317
N Engl J Med. 1988 Dec 29;319(26):1701-7
pubmed: 3205267
J Gerontol A Biol Sci Med Sci. 2007 Aug;62(8):844-50
pubmed: 17702875
Neurology. 2013 Jun 4;80(23):2145-50
pubmed: 23624562
Stroke. 2006 Sep;37(9):2220-41
pubmed: 16917086
Epidemiol Rev. 2013;35:33-50
pubmed: 23349427
J Gerontol A Biol Sci Med Sci. 1995 Jan;50A(1):M28-34
pubmed: 7814786
Ann N Y Acad Sci. 1998 Nov 16;860:360-76
pubmed: 9928325
Hum Mov Sci. 2007 Apr;26(2):275-95
pubmed: 17343947
Stroke. 2009 Apr;40(4):1105-13
pubmed: 19246704
J Am Coll Cardiol. 2011 Oct 4;58(15):1557-65
pubmed: 21958882
Gait Posture. 2017 Feb;52:227-232
pubmed: 27939652
JAMA. 2011 Jan 5;305(1):50-8
pubmed: 21205966
J Gerontol A Biol Sci Med Sci. 2017 May 1;72(5):669-675
pubmed: 27449140
Arch Phys Med Rehabil. 2002 Nov;83(11):1566-71
pubmed: 12422327
Phys Ther. 2006 Dec;86(12):1651-60
pubmed: 17062644
Neurology. 2017 Jul 25;89(4):336-342
pubmed: 28659421
Stroke. 1994 Jun;25(6):1122-9
pubmed: 8202968
J Vasc Surg. 2018 Jul;68(1):256-284
pubmed: 29937033
Stroke. 2005 Nov;36(11):2373-8
pubmed: 16224084
J Atheroscler Thromb. 2017 Jan 1;24(1):39-46
pubmed: 27237221
Neurology. 2010 May 18;74(20):1627-33
pubmed: 20479362
J Am Geriatr Soc. 2012 Nov;60(11):2127-36
pubmed: 23110433
Clin Geriatr Med. 2014 Aug;30(3):421-42
pubmed: 25037289
Circulation. 2017 Aug 22;136(8):719-728
pubmed: 28588075
J Vasc Surg. 2017 Oct;66(4):1083-1092
pubmed: 28712815
Neuropsychology. 2006 Mar;20(2):215-23
pubmed: 16594782
Brain Cogn. 2017 Jul;115:41-46
pubmed: 28433922