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Total and Structural Carotid Artery Stiffness Are Associated With Cognitive Decline and Structural Brain Abnormalities Related to Alzheimer Disease and Alzheimer Disease‐Related Dementias Pathology: The Multi‐Ethnic Study of Atherosclerosis
Jeremy R. Williams, Theodore M. DeConne, Ryan J. Pewowaruk, Claudia E. Korcarz, Jordan E. Tanley, Cynthia M. Carlsson, Susan R. Heckbert, Mohamad Habes et al.. Journal of the American Heart Association, 2025-05-02
Topic: Amyloid, tau and blood-test diagnosis
Background Arterial stiffness is associated with pathological changes underlying Alzheimer disease and related dementias. Total pulse wave velocity can be subdivided into 2 main mechanisms: structural arterial stiffness (S‐PWV) due to intrinsic remodeling of the artery wall and load‐dependent arterial stiffness due to increased blood pressure. Methods and Results In this prospective cohort study, MESA (Multi‐Ethnic Study of Atherosclerosis) participants completed B‐mode carotid ultrasounds from which carotid total pulse wave velocity was calculated. S‐PWV was calculated by adjusting pulse wave velocity to 120/80 mmHg using a nonlinear pressure‐diameter relationship, and load‐dependent arterial stiffness was derived by subtracting S‐PWV from total pulse wave velocity. Participants had repeated cognitive assessments with the Cognitive Abilities Screening Instrument, Digit Symbol Coding, and Digit Span combined into a global cognitive composite (N=2489). Brain magnetic resonance imaging was used to generate total gray matter volume (N=906), white matter hyperintensity volume (N=896), and total white matter fractional anisotropy (N=810). Multivariable linear fixed and mixed effects regression models related standardized pulse wave velocity components to neuroimaging and cognitive decline parameters, respectively. Greater S‐PWV was associated with greater longitudinal cognitive decline in global cognitive composite score (β=–0.05, P =0.002) and subtests, whereas greater load‐dependent arterial stiffness was not associated with longitudinal cognitive decline. Greater S‐PWV was associated with lower gray matter volume (β=–3183.4, P =0.013) and higher log white matter hyperintensity volume (β=0.20, P <0.001), whereas load‐dependent arterial stiffness was associated with lower total white matter fractional anisotropy (β=–0.004, P ≤0.001). Conclusions Higher structural stiffness of the carotid artery is associated with cognitive decline, whereas both structural and load‐dependent stiffness are associated with brain structural abnormalities common in Alzheimer disease‐related dementias.
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APA 7th
Williams, J. R., DeConne, T. M., Pewowaruk, R. J., Korcarz, C. E., Tanley, J. E., Carlsson, C. M., et al. (2025). Total and Structural Carotid Artery Stiffness Are Associated With Cognitive Decline and Structural Brain Abnormalities Related to Alzheimer Disease and Alzheimer Disease‐Related Dementias Pathology: The Multi‐Ethnic Study of Atherosclerosis. Journal of the American Heart Association. https://doi.org/10.1161/jaha.124.039925
Vancouver
Williams JR, DeConne TM, Pewowaruk RJ, Korcarz CE, Tanley JE, Carlsson CM, et al. Total and Structural Carotid Artery Stiffness Are Associated With Cognitive Decline and Structural Brain Abnormalities Related to Alzheimer Disease and Alzheimer Disease‐Related Dementias Pathology: The Multi‐Ethnic Study of Atherosclerosis. Journal of the American Heart Association. 2025. doi:10.1161/jaha.124.039925. PMID: 40314392.
BibTeX
@article{williams2025-40314392,
author = {Williams, Jeremy R. and DeConne, Theodore M. and Pewowaruk, Ryan J. and Korcarz, Claudia E. and Tanley, Jordan E. and Carlsson, Cynthia M. and Heckbert, Susan R. and Habes, Mohamad and others},
title = {{Total and Structural Carotid Artery Stiffness Are Associated With Cognitive Decline and Structural Brain Abnormalities Related to Alzheimer Disease and Alzheimer Disease‐Related Dementias Pathology: The Multi‐Ethnic Study of Atherosclerosis}},
journal = {Journal of the American Heart Association},
year = {2025},
doi = {10.1161/jaha.124.039925},
pmid = {40314392},
url = {https://doi.org/10.1161/jaha.124.039925}
}
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Key findings
- Background Arterial stiffness is associated with pathological changes underlying Alzheimer disease and related dementias.
- Methods and Results In this prospective cohort study, MESA (Multi‐Ethnic Study of Atherosclerosis) participants completed B‐mode carotid ultrasounds from which carotid total pulse wave velocity was calculated.
- Greater S‐PWV was associated with greater longitudinal cognitive decline in global cognitive composite score (β=–0.05, P =0.002) and subtests, whereas greater load‐dependent arterial stiffness was not associated with longitudinal cognitive decline.
- Greater S‐PWV was associated with lower gray matter volume (β=–3183.4, P =0.013) and higher log white matter hyperintensity volume (β=0.20, P <0.001), whereas load‐dependent arterial stiffness was associated with lower total white matter fractional anisotropy (β=–0.004, P ≤0.001).
- Conclusions Higher structural stiffness of the carotid artery is associated with cognitive decline, whereas both structural and load‐dependent stiffness are associated with brain structural abnormalities common in Alzheimer disease‐related dementias.
Why it matters
This cohort study found that greater structural carotid artery stiffness was associated with greater longitudinal cognitive decline and structural brain abnormalities related to Alzheimer's disease and related dementias. It identifies a vascular risk factor but does not test a treatment, cure, or prevention.
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Study details
- Study designcohort study
- Participants2,489
- Evidence strengthModerate
How this study scored 59/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Heart Association) |
| Journal's citation record | 2 / 4 | Journal of the American Heart Association: journal h-index 200 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 3 / 4 | 2,489 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 11 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 3.7 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 3 / 6 | Cited 7.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 1 other studies in this library |
| Still being cited | 1 / 4 | Cited 11 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Adam D. Gepner: h-index 24 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | University of Washington: institution h-index 3,540 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 7 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40314392) |
| Free to read | 2 / 2 | Free to read |
| Total | 59 / 100 | — |
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Read the original
- DOI: 10.1161/jaha.124.039925
- PubMed: 40314392
- Original source →
- Free full text: Journal of the American Heart Association →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
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