Carotid Intimal Medial Thickness Predicts Cognitive Decline Among Adults Without Clinical Vascular Disease
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Background and Purpose— Though clinical cardiovascular and cerebrovascular diseases are established risk factors for cognitive decline and dementia, less is known about the relations between vascular health and cognition among individuals without these diseases. Carotid intimal medial thickness (IMT), a measure of subclinical vascular disease, is associated with concurrent decrements in cognitive function, but relatively little research has examined longitudinal relations between carotid IMT and prospective cognitive decline. Methods— We examined relations of carotid IMT to prospective trajectories of cognitive function among 538 (aged 20 to 93, 39% male, 66% white) participants in the Baltimore Longitudinal Study of Aging (BLSA) free of known cardiovascular, cerebrovascular, and neurological disease. Participants underwent initial carotid ultrasonography and repeat neuropsychological testing on up to 8 occasions over up to 11 years of follow-up. Mixed-effects regression analyses were adjusted for age, gender, race, education, mean arterial pressure, body mass index, total cholesterol, smoking, depressive symptoms, and cardiovascular medication use. Results— Individuals with greater carotid IMT displayed accelerated decline in performance over time on multiple tests of verbal and nonverbal memory, as well as a test of semantic association fluency and executive function. Conclusions— Carotid IMT predicts accelerated cognitive decline, particularly in the domain of memory, among community-dwelling individuals free of vascular and neurological disease.
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Proposed mechanisms linking atherosclerotic cerebrovascular pathology to vascular cognitive impairment include thrombotic occlusion of large vessels with subsequent chronic cerebral hypoperfusion, cerebral embolism from ruptured or thrombotic carotid plaques targeting distal vessels, increased parenchymal oxidative stress, blood pressure dysregulation affecting blood-brain barrier integrity, and a
“The mechanisms by which atherosclerotic cerebrovascular pathology might be associated with VCI include thrombotic occlusion of large vessels with subsequent chronic cerebral hypoperfusion; cerebral embolism originating from ruptured or thrombotic carotid plaques and targeting distal vessels; increased parenchymal oxidative stress; blood pressure dys-regulation affecting BBB integrity; and a common”
From Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (2011) · cites this paper as [189]
The Discussion proposes chronic cerebral hypoperfusion as a mechanism linking subclinical vascular disease to cognitive impairment. It does not specify thrombotic large-vessel occlusion as its cause, or describe plaque-derived embolism, parenchymal oxidative stress, or blood-pressure dysregulation affecting blood–brain barrier integrity. No page number is available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredCarotid atherosclerosis and intima-media thickness have been associated with cardiovascular risk factors, including metabolic, inflammatory, and dietary factors, that have also been associated with cognitive decline.
“Carotid atherosclerosis and IMT have been associated with cardiovascular risk factors, including metabolic, inflammatory, and dietary factors, that have also been associated with cognitive decline.189–192”
From Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (2011) · cites this paper as [189]
The Discussion (page not provided) links carotid atherosclerosis with metabolic, immunologic, and lifestyle factors associated with lower cognitive function; it does not specifically identify dietary factors. The paper also reports that greater carotid IMT predicts cognitive decline, but the cited Discussion passage links the risk-factor categories to lower cognitive function rather than decline. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe relationship between carotid intima-media thickness and cognitive function has been analyzed cross-sectionally and longitudinally in few studies.
“The relationship between carotid IMT and cognitive function has been analyzed cross-sectionally185,186 and longitudinally187–189 in few studies.”
The inverse relationship between carotid intima-media thickness and cognition was significant after controlling for age and education; some studies further adjusted for depressive symptoms and/or cardiovascular risk factor level.
“This relationship was significant after controlling for age and education; some studies further adjusted for the presence of depressive symptoms187,189 and/or cardiovascular risk factor level.189”
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- Authors
- Wendell, C. R., Zonderman, A. B., Metter, E. J., Najjar, S. S., & Waldstein, S. R.
- Affiliations
- University of Maryland, Baltimore (US)
- Venue
- Stroke
- Published
- 2009-10
- Volume
- 40
- Issue
- 10
- Pages
- 3180-3185
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- PMC
- PMC2753681
- OpenAlex
- W2134447856
- Cited by
- 158
- References
- 37
- Citations by year
- 2026: 7 · 2025: 3 · 2024: 6 · 2023: 5 · 2022: 10 · 2021: 3 · 2020: 3 · 2019: 6 · 2018: 8 · 2017: 13 · 2016: 16 · 2015: 9 · 2014: 10 · 2013: 16 · 2012: 16
- FWCI
- 8.84
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute on Aging (Z01AG000195)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
- Keywords
- carotid intima-media thickness, cognitive decline, subclinical vascular disease, memory decline, executive function, semantic fluency, dementia risk, aging, community-dwelling adults, longitudinal cognitive trajectories
- MeSH terms
- Adult, Aged, Aged, 80 and over, Aging, Carotid Arteries, Cognition Disorders, Dementia, Female, Humans, Male, Memory Disorders, Middle Aged, Neuropsychological Tests, Predictive Value of Tests, Prospective Studies, Ultrasonography, Comorbidity, Carotid Stenosis, Tunica Intima, Young Adult
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