Abstract
Background and aims
Coronary arterial calcification on CT (CT-CAC) predicts coronary events, but although intracranial arterial calcification on CT brain imaging (CT-IAC) is a frequent finding in older individuals, there is no consensus on its prognostic significance, particularly whether its presence, severity, or site predict cognitive impairment/dementia. We did a systematic review and meta-analysis to assess these associations.
Methods
Studies published before 4-Dec-2025 were identified from bibliographic databases, reference lists, and forward or backward screening. Inclusion criteria were: (1) Studies of adults linking CT-IAC/CAC with cognitive impairment/dementia; (2) reporting adjusted effect measures with 95%CI/p-values (or calculable); (3) calcification assessed by CT/CT angiography and cognition by recognised tests or expert evaluation.
Results
Six cross-sectional studies and three longitudinal studies reported CT-IAC and cognition data. CT-IAC presence was weakly associated with cognitive impairment/dementia (three cross-sectional studies – adjusted OR=1.42,0.88-2.28,p=0.15; two longitudinal studies – aOR=1.51,1.03-2.22,p=0.033; all – aOR=1.48,1.10-1.99,p=0.01; Fig. 1). More severe vs. milder CT-IAC was more strongly associated with cognitive impairment/dementia (two cross-sectional studies – aOR=2.29,0.50-10.57,p=0.29; three longitudinal studies – aOR=1.84,1.28-2.65,p=0.001; all – aOR=1.74,1.28-2.36,p=0.0004; Fig. 2), including in two longitudinal cohorts in stroke/TIA patients (aOR=1.73,1.22-2.46,p=0.002). In two longitudinal studies, medial CT-IAC severity was a stronger predictor of dementia (aOR=2.35,1.29-4.28,p=0.005) than intimal CT-IAC (aOR=1.29,0.75-2.23,p=0.36). For CT-CAC, three longitudinal cohorts revealed weak associations with dementia (per SD CT-CAC – adjusted HR=1.15,1.02-1.30,p=0.025).
Conclusions
Presence and severity of CT-IAC are both independently associated with dementia, with consistent estimates in cross-sectional and longitudinal studies, driven mainly by medial calcification.
Conflict of interest
Dr Ke (Michael) Li is supported by the Clarendon and COSF Funds. Dr Oluwaseemo Osomo has nothing to disclose. Prof Rothwell and the Oxford Vascular Study are supported by grants from the Wellcome Trust and the NIHR Biomedical Research Centre, Oxford.
Figure 1 - belongs to Conclusions
Figure 2 - belongs to Conclusions
