Table 1.

Overview of feature of asymptomatic carotid atherosclerosis and their potential association with cognitive dysfunction and dementia.

Atherosclerosis feature	Imaging features	Potential mechanistic association with dementia	Supportive studies
Arterial stiffness	Central: Generally measured via pulse wave velocity Carotid: Generally measured directly with Ultrasound (US) based measurement of the carotid artery	Lack of vascular distensibility leads to increased flow load experienced by cerebral parenchyma	Central arterial stiffness may relate to cognitive impairment (24–32) Carotid stiffness is associated with cognitive impairment (33–38)
Carotid intima-media thickening	Measured via US in either the distal common carotid or proximal internal carotid artery	Similar mechanism as arterial stiffness and marker for generalized cardiovascular risk	Cross-sectional (39–43) and prospective (44–46) association between increased CIMT and cognitive impairment
Flow-limiting stenosis	Measured on either US, CT angiography, MR angiography, or digital subtraction angiography. Most commonly graded using NASCET criteria	Hypoperfusion from flow-limitations or potentially increased small infarctions	Association of flow-limiting stenosis to cognitive impairment (47–54); Changes to cognition after revascularization (55–59)
High-risk plaque features	Various features indicate “higher risk” including the presence of intraplaque hemorrhage, lipid-rich necrotic core, plaque ulceration, or increased plaque thickness/volume	Increased small covert brain infarctions or other markers of cerebral small vessel disease	High plaque volume and/or vulnerable plaque is associated with cognitive impairment (60–66)