Prevalence, volume, and clinical correlates of intracranial arteriosclerosis among patients with cognitive complaints: A clinic-based study

BACKGROUND:

Intracranial arteriosclerosis increases the risk of dementia in the general population, but no published studies have determined its clinical value for the diagnosis of vascular cognitive impairment in a memory clinic setting.

METHOD: 

We included 317 patients (mean age: 69.9 years, 44% female) who attended the Erasmus MC Alzheimer Center between 2016 and 2021, and underwent non-contrast multi-detector computed tomography (MDCT) scans as part of their diagnostic workup. We determined the prevalence and volume of intracranial artery calcification in the internal carotid artery and vertebrobasilar arteries, as a marker of intracranial arteriosclerosis, and compared these to prevalence and volume in an age- and sex-matched sample of the population-based Rotterdam Study. Finally, we assessed cognitive function using comprehensive neuropsychological tests and determined the explained variance in cognitive performance when adding intracranial calcification to a model including age, sex and cardiovascular risk factors. 

RESULT: 

Overall prevalence of intracranial artery calcification was 89.91% (95%CI: 85.92-92.89%), higher in the internal carotid artery (89.3% [85.9%-92.7%] than in the vertebrobasilar arteries (29.3% [24.3%-34.3%]). Prevalence of calcification was higher in women than in men in the internal carotid artery, while men -if affected- had larger volumes of calcification. Prevalence of both anterior and posterior circulation calcification was higher among memory clinic patients than in the age- and sex-matched reference population (internal carotid artery: OR [95%CI] 2.22 [1.24-3.97]; and vertebrobasilar arteries: OR 1.40 [1.04-1.89]). Analysis of cognitive function will be presented at the conference.

CONCLUSION: 

The vast majority of patients attending a memory clinic have evidence of intracranial arteriosclerosis, with higher prevalence and volume of calcification than age and sex-matched reference participants in the general population. In ongoing analyses we explore the utility of intracranial arteriosclerosis imaging for the diagnosis of vascular cognitive impairment.