Association of carotid intima-media thickness and other carotid ultrasound features with incident dementia in the aric-ncs

Wendy Wang, Faye L. Norby, Kristen M. George, Alvaro Alonso, Thomas H. Mosley, Rebecca F. Gottesman, Michelle L. Meyer, Pamela L. Lutsey

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


BACKGROUND: Increased carotid intima-media thickness, interadventitial diameter, presence of carotid plaque, and lower dis-tensibility are predictors for cardiovascular disease. These indices likely relate to cerebrovascular disease, and thus may constitute a form of vascular contributions to dementia and Alzheimer disease– related dementia. Therefore, we assessed the relationship of carotid measurements and arterial stiffness with incident dementia in the ARIC (Atherosclerosis Risk in Communities) study. METHODS AND RESULTS: A total of 12 459 ARIC participants with carotid arterial ultrasounds in 1990 to 1992 were followed through 2017 for dementia. Dementia cases were identified using in-person and phone cognitive status assessments, hospitalization discharge codes, and death certificate codes. Cox proportional hazards models were used to estimate the hazard ratios (HRs) for incident dementia. Participants were aged 57±6 at baseline, 57% were women, and 23% were Black individu-als. Over a median follow-up time of 24 years, 2224 dementia events were ascertained. After multivariable adjustments, the highest quintile of carotid intima-media thickness and interadventitial diameter in midlife was associated with increased risk of dementia (HR [95% CIs], 1.25 [1.08–1.45]; and 1.22 [1.04–1.43], respectively) compared with its respective lowest quintile. Presence of carotid plaque did not have a significant association with dementia (HR [95% CI], 1.06 [0.97–1.15]). Higher distensibility was associated with lower risk of dementia (HR [95% CI] highest versus lowest quintile, 0.76 [0.63– 0.91]). CONCLUSIONS: Greater carotid intima-media thickness, interadventitial diameter, and lower carotid distensibility are associated with an increased risk of incident dementia. These findings suggest that both atherosclerosis and carotid stiffness may be implicated in dementia risk.

Original languageEnglish (US)
Article numbere020489
JournalJournal of the American Heart Association
Issue number9
StatePublished - 2021

Bibliographical note

Funding Information:
The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). Neurocognitive data were collected by U01 2U01HL096812, 2U01HL096814, 2U01HL096899, 2U01HL096902, 2U01HL096917 from the National Institutes of Health (National Heart, Lung, and Blood Institute; National Institute of Neurological Disorders and Stroke, National Institute on Aging, and National Institute on Deafness and Other Communication Disorders), and with previous brain magnetic resonance imaging examinations funded by R01-HL70825 from the National Heart, Lung, and Blood Institute. This work was also supported by grants from the National Institute of General Medical Sciences (T32GM132063 [Ms Wang]); the National Heart, Lung, and Blood Institute (K24HL148521 [Dr Alonso], K24AG052573 [Dr Gottesman]); and the American Heart Association (16EIA26410001 [Dr Alonso]).

Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.


  • Carotid intima-media thickness
  • Dementia
  • Epidemiology
  • Risk factors


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