Key result
Extracranial carotid plaque is linked to an ~83% higher risk of cognitive dysfunction.
Why the study?
The role of extracranial carotid plaque in contributing to cognitive impairment and dementia was uncertain compared to prior focus on carotid intima media thickness or stenosis.
Meta-Analysis (n=46,354)
Odds Ratio: 1.83 (95% CI 1.5–2.24)
Carotid plaque association with cognitive impairment remains uncertain; leaves open causal role and need for longitudinal studies before clinical consideration.
BACKGROUND: Extracranial carotid atherosclerosis has been variably associated with dementia. Prior studies have focused on the association of carotid intima media thickness or carotid stenosis; however, there is evidence that carotid plaque may contribute to dementia, perhaps via microembolic phenomena. OBJECTIVES: We sought to evaluate the role of carotid plaque in contributing to cognitive impairment by performing a systematic review and meta-analysis to summarize the association between extracranial carotid plaque and cognitive dysfunction and dementia. METHODS: We performed a comprehensive literature search evaluating the association of extracranial carotid plaque with cognition. We included studies measuring carotid plaque on ultrasound, computed tomography, or MR and also evaluated cognition through neuropsychological testing. Meta-analyses with assessment of study heterogeneity and publication bias were performed. Results were presented in a forest plot and summarized using a random-effects model. RESULTS: After screening 1,674 studies, we included 40 for systematic review and 16 and 7 studies for two meta-analyses with a total of 19,029 and 27,325 patients, respectively. We found a positive relationship between the presence of extracranial carotid plaque and cognitive dysfunction with a pooled random-effects odds ratio (OR) of 1.83 (95% CI, 1.50, 2.24) and a pooled random-effects hazard ratio (HR) of 1.47 (95% CI, 1.15, 1.89), respectively. A sensitivity analysis of only longitudinal studies found a persistent positive association. Measures of heterogeneity showed moderate heterogeneity in each meta-analysis, respectively (I-squared statistic = 57% and 70%). CONCLUSION: The presence of extracranial carotid plaque is significantly associated with cognitive dysfunction and dementia in both cross-sectional and longitudinal analyses. After further confirmation, our results support carotid plaque being a potentially modifiable risk factor in the development of dementia.
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Baradaran et al. (2022) conducted a meta-analysis in Cognitive dysfunction and dementia (n=46,354). Extracranial carotid plaque vs. Absence of extracranial carotid plaque was evaluated on Cognitive dysfunction (OR 1.83, 95% CI 1.50-2.24). The presence of extracranial carotid plaque was significantly associated with cognitive dysfunction (OR 1.83; 95% CI 1.50-2.24) and dementia (HR 1.47; 95% CI 1.15-1.89).
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