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Asymptomatic carotid artery stenosis, cognitive decline and dementia: a prospective population-based cohort study
Box, C. V. J.; Pomp, A.; Yu, Q.; Kavousi, M.; Ikram, M. K.; van der Lugt, A.; Bos, D.; Wolters et al.. medRxiv (preprint), 2026-08-21
Topic: Risk, prevention and care in population studies
BackgroundAsymptomatic carotid artery stenosis (ACAS) increases the risk of stroke, and is associated with cognitive decline. Compared to individuals without carotid atherosclerosis, risk of dementia was increased in the presence of plaque without stenosis (HR: 1.39 [95%CI: 1.05-1.83]) and occlusion (HR: 4.61 [1.82-11.66]), but not with stenosis (HR 1-49% stenosis: 1.08 [0.84-1.39]; 50-99% stenosis: 1.18 [0.70-1.99]). Results did not differ consistently by plaque characteristics. ConclusionRisk of dementia was increased with asymptomatic carotid artery plaque and occlusion, but not significantly with 50-99% stenosis. These results are in line with detrimental effects of generalised atherosclerotic disease and severe haemodynamic impairment on cognitive decline and dementia risk. We found consistent evidence for an association between multiple measures of carotid atherosclerosis and dementia. What this study addsIn this large prospective cohort study, we found that risk of dementia was increased with carotid plaque without stenosis and full occlusion, but no significant effect was found with mild, moderate or severe stenosis. Our findings further caution about haemodynamic consequences on cognition in patients with complete occlusion, but do not support revascularisation for the benefit of cognition in most cases with ACAS.
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APA 7th
Box, C. V. J., Pomp, A., Yu, Q., Kavousi, M., Ikram, M. K., van der Lugt, A., et al. (2026). Asymptomatic carotid artery stenosis, cognitive decline and dementia: a prospective population-based cohort study. medRxiv (preprint). https://doi.org/10.64898/2026.08.18.26360680
Vancouver
Box CVJ, Pomp A, Yu Q, Kavousi M, Ikram MK, van der Lugt A, et al. Asymptomatic carotid artery stenosis, cognitive decline and dementia: a prospective population-based cohort study. medRxiv (preprint). 2026. doi:10.64898/2026.08.18.26360680.
BibTeX
@article{box2026-2d17ea82,
author = {Box, C. V. J. and Pomp, A. and Yu, Q. and Kavousi, M. and Ikram, M. K. and van der Lugt, A. and Bos, D. and Wolters and others},
title = {{Asymptomatic carotid artery stenosis, cognitive decline and dementia: a prospective population-based cohort study}},
journal = {medRxiv (preprint)},
year = {2026},
doi = {10.64898/2026.08.18.26360680},
url = {https://doi.org/10.64898/2026.08.18.26360680}
}
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Key findings
- BackgroundAsymptomatic carotid artery stenosis (ACAS) increases the risk of stroke, and is associated with cognitive decline.
- Compared to individuals without carotid atherosclerosis, risk of dementia was increased in the presence of plaque without stenosis (HR: 1.39 [95%CI: 1.05-1.83]) and occlusion (HR: 4.61 [1.82-11.66]), but not with stenosis (HR 1-49% stenosis: 1.08 [0.84-1.39]; 50-99% stenosis: 1.18 [0.70-1.99]).
- Results did not differ consistently by plaque characteristics.
- ConclusionRisk of dementia was increased with asymptomatic carotid artery plaque and occlusion, but not significantly with 50-99% stenosis.
- These results are in line with detrimental effects of generalised atherosclerotic disease and severe haemodynamic impairment on cognitive decline and dementia risk.
Why it matters
Risk of dementia was higher with carotid plaque without stenosis and with full occlusion, but no significant effect was found with mild, moderate or severe stenosis. The authors say their findings do not support revascularisation for cognitive benefit in most cases with asymptomatic carotid artery stenosis.
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Study details
- Study designsystematic review
- Participants4,267
- Effect size55.5%; 11.3%; 23.2%
- Evidence strengthHigh
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 57 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. We have no data on times cited, citations per year, impact for its field and year, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 39 of the 68 points we could judge it on, which is 57 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (medRxiv (preprint)) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 12 / 12 | A systematic review of all the studies on the question |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 3 / 4 | 4,267 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Points | 39 / 68 | Scored on 13 of 20 parts. We have no data for the rest, so they are left out: 39 of the 68 points we could judge it on is 57 out of 100. |
| Total | 57 / 100 | Capped to 16 because this is not a peer-reviewed article. |
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