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In Reply: Dr Zazulia points out that large randomized controlled trials have failed to demonstrate a benefit for revascularization therapy in women with asymptomatic carotid disease. In this context, asymptomatic indicates an absence of ipsilateral TIA or stroke symptoms rather than an absence of cognitive decline, which indeed has been linked with carotid disease.¹

While I agree with Zazulia's evidence-based comment, it does not bear directly on my suggestion that carotid ultrasound studies be considered in the assessment of a 60-year-old woman with mild cognitive impairment and vascular risk factors. Results from a community-based study of mild cognitive impairment suggest a significant likelihood of abnormal carotid ultrasound findings in Ms E based on her multiple domain symptoms.²

Carotid study findings in Ms E, who lacks a history of stroke or TIA symptoms, would not be used to justify carotid endarterectomy or stenting, given the superiority of medical over surgical management . . . [Full Text of this Article]

James M. Ellison, MD, MPH
ellisonj@mcleanpo.mclean.org
Geriatric Psychiatry Program
McLean Hospital
Belmont, Massachusetts

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RELATED LETTER

Mild Cognitive Impairment, Carotid Disease, and Revascularization
Allyson Zazulia
JAMA. 2009;301(8):829.
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