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Cognitive Performance in Asymptomatic Patients With Advanced Carotid Disease

Martinic Popovic, Irena MD, PhD*; Lovrencic-Huzjan, Arijana MD, PhD*; Simundic, Ana-Maria PhD; Popovic, Alek MD, PhD; Seric, Vesna MD, PhD*; Demarin, Vida MD, PhD*

Cognitive & Behavioral Neurology:
doi: 10.1097/WNN.0b013e3182313020
Original Studies

Objective: In the absence of stroke or transient ischemic attack, patients with advanced carotid stenosis or occlusion (ICAs/o) are considered asymptomatic, yet they are prone to mostly subtle cognitive impairment.

Background: The Mini-Mental State Examination (MMSE) often fails to detect mild cognitive impairment. The Montreal Cognitive Assessment (MoCA) is more sensitive in recognizing such changes.

Methods: Scores on the MoCA and MMSE were compared in 70 asymptomatic patients with ICAs/o and 70 controls matched for demographic variables and vascular risk factors.

Results: MMSE scores fell mostly within the normal range in both patients and controls. Differences were significant for total MoCA scores (P<0.001). Patients with ICAs/o performed worse on visuospatial and executive function (P=0.018), abstraction (P<0.001), and delayed recall (P<0.001). Lower MoCA scores were associated with diabetes (odds ratio=6.41; 95% confidence interval, 1.277-32.220; P=0.024) and older age (odds ratio=0.86; 95% confidence interval, 0.780-0.956; P=0.004). Patients with diabetes performed worse on delayed recall (P<0.001), and patients with hypertension were worse on the MoCA naming subtest (P=0.04).

Conclusions: The MoCA successfully identified reduced cognitive status in patients with ICAs/o. The MoCA subtest scores revealed a pattern of cognitive impairment similar to that documented in other studies using more extensive neuropsychological tests. MoCA could be used as part of the clinical evaluation of patients with ICAs/o.

Author Information

*University Department of Neurology

Clinical Institute of Chemistry

University Department of Urology, “Sestre milosrdnice” University Hospital Centre, Zagreb, Croatia

The authors declare no conflicts of interest.

Reprints: Irena Martinic Popovic, MD, PhD, University Department of Neurology, “Sestre milosrdnice” University Hospital Centre, Vinogradska c. 29, Zagreb 10000, Croatia (e-mail:

Received March 15, 2011

Accepted August 3, 2011

© 2011 Lippincott Williams & Wilkins, Inc.