Abstract Body: Background: Previous reports have established a relationship between asymptomatic high-grade carotid artery stenosis (CAS) and impaired cognition. Different forms of cardiac disease have also been associated with cognitive impairment and dementia. The effect of concurrent high-grade CAS and cardiac disease on cognition is unknown. We hypothesize the presence of comorbid cardiac disease has a synergistic effect on cognitive impairment in patients with asymptomatic CAS.

Methods: Patients with ≥80% internal carotid artery stenosis with no history of stroke were recruited from inpatient and outpatient practices at a single, large, comprehensive stroke center. Patients with vs without comorbid cardiac disease (coronary artery disease [CAD], CAD with history of coronary artery bypass graft [CABG] or percutaneous intervention [PCI], heart failure [HF], atrial fibrillation [AF], or valvular disease [aortic or mitral]) were identified. Cognitive assessments were performed using a battery of 14 standardized tests of attention, memory, processing speed, visual construction, language and executive function. Z-scores were generated based on age-specifc norms. Multivariable linear regression was used to compare test-specific Z-scores in patients with vs without cardiac disease controlling for age, sex, years of education and depression.

Results: Thirty-three patients with asymptomatic CAS were identified (21 males, age 74+/-10 years, education=16+/-3 years). Twenty-six (79%) had cardiac disease. Patients with comorbid cardiac disease had significantly lower Z-scores across multiple tests of memory compared to patients without cardiac disease (Fig). After adjusting for age, sex, years of education and depression, significant differences persisted in tests of memory in patients with CAD [Hopkins Recognition Memory Test, β= -1.127 (95% CI: -2.234, -0.020), P=0.046], CABG [Hopkins Learning Trial Memory Test, β= -1.441 (95% CI: -2.532, -0.350), P=0.012], and valvular disease [Hopkins Learning Trials Memory Test, β= -1.121 (95% CI: -2.224, -0.018), P=0.047].

Conclusion: Cardiac disease is common among patients with asymptomatic high-grade carotid stenosis and may have a synergistic effect on impairments in memory in a manner not mediated by stroke. Further work is needed to confirm these relationships and their longterm implications on vascular brain health.