The effect of carotid atherosclerosis and revascularization on cognition and dementia: a systematic review and meta-analysis

Carotid artery intima-media thickness and asymptomatic steno-occlusive disease are linked to higher dementia risk, with hazard ratios of 1.07 per 1-SD and 1.48.

• Why it matters: Evidence on whether carotid atherosclerosis accelerates cognitive decline is fragmented, and whether carotid revascularization helps cognition or prevents dementia remains uncertain.
• What they did: A systematic review and meta-analysis searched multiple databases to 11 November 2024, excluding dementia-only or no-reference studies and follow-up under 30 days; it included 97 studies (43 observational, N=100,326; 54 intervention, N=15788, including 6 RCTs).
• The result: Observational data in mostly stroke-free people showed dementia associations, while cognitive outcomes were too heterogeneous for pooling; non-randomized interventions suggested improved global cognition (SMD 0.73, 95%CI 0.37–1.09) but revascularization did not support cognitive decline or dementia prevention in CREST-2 and ACAS/ACST-1.

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