Severity of intracranial arterial calcification on computed tomography and risk of dementia in patients with stroke or transient ischaemic attack: a population-based study

Journal article

Background: Coronary arterial calcification is a widely studied risk factor for acute coronary events, but although intracranial arterial calcification on computed tomography brain imaging (CT-IAC) is also a frequent finding, particularly in older individuals, few longitudinal studies have assessed whether its severity or site predict cognitive impairment and dementia. Given the potential clinical and mechanistic importance of any such associations, we did a population-based study in patients with transient ischaemic attack (TIA) or stroke.

Methods: In a matched case-control study of patients with minor stroke or TIA nested in the population-based Oxford Vascular Study (OXVASC) cohort, the severity (qualitatively and semi-automated volume) and location (intimal or internal elastic lamina) of CT-IAC in cases who developed dementia on follow-up was compared with that in age/sex-matched controls who did not (logistic regression adjusted for other risk factors).

Results: In OXVASC (cases/controls=200/200; mean age/standard deviation=78.0/9.3), dementia was independently associated with severity of internal carotid artery (ICA) CT-IAC on the visual scale (bilateral severe calcification – adjusted OR [aOR]=2.02, 1.26-3.23, p=0.004) and as quantitative volume (top vs. bottom tertile – aOR=2.35, 1.33-4.16, p=0.003), driven mainly by the small number of individuals with very high calcification volumes (≥600 mm^3 vs. 0-299 mm^3 – aOR=6.23, 1.24-31.24, p=0.026). Similar trends were observed for CT-IAC in the ICA and vertebrobasilar artery combined (top vs. bottom tertile – aOR=2.59, 1.43-4.68, p=0.002), including after exclusion of recurrent stroke (aOR=2.60, 1.33-5.08, p=0.005) and of patients with moderate/severe white matter disease (aOR=3.19, 1.54-6.62, p=0.002). ICA CT-IAC of the internal elastic lamina subtype independently predicted dementia after adjusting for qualitative (aOR=1.84, 1.11-3.05, p=0.019) or quantitative (aOR=1.78, 1.06-2.99, p=0.029) CT-IAC severity.

Conclusion: Severity of CT-IAC is an independent predictor of future dementia after stroke/TIA. The extent of any non-linearity of the association and any calcification- or dementia-subtype differences should be determined in larger studies.

Authors: Li, MK; Simonato, D; Rothwell, P

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Wiley
• Journal: Journal of the American Heart Association Cardiovascular and Cerebrovascular Disease
• Publication date: 2026-03-04
• Acceptance date: 2025-12-31
• DOI: 10.1161/JAHA.125.046801
• EISSN: 2047-9980
• Language: English
• Keywords: dementia; intracranial arterial calcification; stroke