Does extracranial arterial pathology play a role in late-onset psychiatric disorders?

Introduction: Carotid interventions are commonly performed to reduce the risk of disabling stroke and stroke-related death. Carotid interventions may also have an effect on cognitive functions. Mental disorders in the elderly have been related to structural brain pathology. This review of literature was performed to test the hypothesis that atherosclerotic lesions in the carotid and vertebral arteries may have an impact on the development and treatment of late-onset psychiatric disorders. Methods: A literature search identified articles focusing on the key issues using the Pubmed and Cochrane databases. Results: Cardiovascular risk factors seem to be increased in patients with late-onset mania, depression, and schizophrenia. Cerebral infarctions, especially right-sided, have repeatedly been associated with various psychiatric disorders. Several case reports suggest that chronic cerebral hypoperfusion may also induce psychiatric disease and that these disorders might disappear after reconstruction. Conclusions: There seems to be an association between occlusive carotid and vertebral disease and the late-onset of various psychiatric disorders. Both thromboembolic and chronic cerebral hypoperfusion might contribute to its pathophysiology. This group of patients might benefit from an intervention.