Abstract TP443: Early Cognitive Decline in Patients with Symptomatic Carotid Stenosis is Related to Plaque Inflammation and Concomitant Intracranial Stenosis
Bibliographic record
Abstract
Background and aims: Symptomatic carotid stenosis is associated with an increased risk of early stroke recurrence. Post-stroke vascular cognitive impairment is highly prevalent with significant functional consequences. However, reliable biomarkers for early prediction of cognitive decline are not well established. We postulated that regional hypoperfusion due to carotid stenosis would impair cognitive performance. Hence, we evaluated the cognitive parameters at baseline and their natural course during 90-days of follow up. Methods: This ongoing prospective study included consecutive patients within 30-days of recent stroke and ipsilateral carotid stenosis (≥50%). Data regarding demographics and vascular risk factors were recorded. Cognitive parameters were assessed with the 30-point mini-mental scale (MMSE) and Montreal Cognitive Assessment (MoCA). All patients underwent carotid duplex sonography and 18-fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) of carotid arteries. Embolic potential of the carotid plaque is estimated by presence of spontaneous microembolic signals (MES) on extended transcranial Doppler monitoring of the middle cerebral arteries. Patients are followed prospectively for change in cognitive parameters. Results: Of the 33 patients included in this study, 7 (21%) demonstrated deterioration of their cognitive parameters (MMSE in 4, MOCA in 5 and both in 6) during 90-day follow up. Only high Standard Uptake Value (SUV) on PET (3.62g/ml in cognitive-deterioration group versus 1.72g/ml in the unaffected group; p=0.01) and presence of concomitant intracranial stenosis (p=0.01) were associated with cognitive deterioration. Of the 7 cases who underwent carotid revascularization, 5 (71%) demonstrated improved cognitive performance at day-90. Conclusions: Early cognitive decline is common among patients with symptomatic stenosis of the extracranial carotid artery, especially when associated with concomitant intracranial stenosis and plaque inflammation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".