Arterial calcification in the heart–brain axis and cognitive performance over time

BACKGROUND: While cross-sectional studies suggest a link between arteriosclerosis and cognition, longitudinal research is lacking. We investigated how arteriosclerosis in the heart-brain axis is related to cognitive performance trajectories over time. METHODS: Within the population-based Rotterdam Study, 2368 participants underwent noncontrast CT to quantify arterial calcification, a hallmark of arteriosclerosis, in five major arteries in the heart-brain axis. Following this scan, participants underwent repeated cognitive testing. The association between baseline calcification and longitudinal cognitive test performance was investigated using mixed models. RESULTS: Higher calcification was associated with worse baseline cognitive performance across domains (e.g., β for global cognition per 10-percentile increase of intracranial carotid artery calcification: -0.01 [95% confidence interval (CI): -0.03, -0.00]). Cognition declined faster across all cognitive tests, specifically for the intracranial carotid artery (p ≤ 0.001). DISCUSSION: Arterial calcification is associated with accelerated cognitive decline across domains, especially for arteries closer to the brain. This effect may be attributable to hemodynamic changes preceding neurovascular damage. HIGHLIGHTS: Arterial calcification is related to accelerated cognitive decline. Arterial calcification closer to the brain exerts the most influence on cognitive decline. Vascular damage influences cognitive decline across various domains.