Carotid plaque burden and hemodynamic alterations are associated with domain-specific cognitive impairment in community-dwelling older adults.

Carotid atherosclerosis has been linked to cognitive decline, but evidence regarding its association with domain-specific cognitive performance in understudied non-Western populations remains limited. We investigated the associations of carotid plaque burden and hemodynamic markers with cognitive impairment in 100 community-dwelling Egyptian adults aged ≥ 60 years without prior neurological disease. Carotid plaque burden was quantified by duplex ultrasound using plaque score, and cognition was assessed using the Montreal Cognitive Assessment (MoCA). Sixty-one Participants with a MoCA score ≤ 25 were classified as having possible mild cognitive impairment (MCI). Carotid plaques were detected in 53 participants, and plaque scores were higher in participants with possible MCI (p = 0.035). Internal carotid artery resistive index (ICA RI) was also higher (p = 0.011) among participants with possible MCI. In two separate multivariable models, plaque score (OR 1.41, 95% CI 1.06-1.86; p = 0.020) and ICA RI (OR 1.87, 95% CI 1.01-3.46; p = 0.046) were independently associated with possible MCI. Lower educational attainment showed the strongest association in both models. Plaque burden was most strongly associated with visuospatial and language performance. This cross-sectional study supports further longitudinal studies to determine whether carotid ultrasound markers predict subsequent cognitive decline.