Arterial calcification in the heart–brain axis and cognitive performance over time

BACKGROUND: While cross-sectional studies suggest a link between arteriosclerosis and cognition, longitudinal research is lacking. We investigated how arteriosclerosis in the heart–brain axis is related to cognitive performance trajectories over time. METHODS: Within the population-based Rotterdam Study, 2368 participants underwent noncontrast CT to quantify arterial calcification, a hallmark of arteriosclerosis, in five major arteries in the heart–brain axis. Following this scan, participants underwent repeated cognitive testing. The association between baseline calcification and longitudinal cognitive test performance was investigated using mixed models. RESULTS: Higher calcification was associated with worse baseline cognitive performance across domains (e.g., β for global cognition per 10-percentile increase of intracranial carotid artery calcification: −0.01 [95% confidence interval (CI): −0.03, −0.00]). Cognition declined faster across all cognitive tests, specifically for the intracranial carotid artery (p ≤ 0.001). DISCUSSION: Arterial calcification is associated with accelerated cognitive decline across domains, especially for arteries closer to the brain. This effect may be attributable to hemodynamic changes preceding neurovascular damage. Highlights: Arterial calcification is related to accelerated cognitive decline. Arterial calcification closer to the brain exerts the most influence on cognitive decline. Vascular damage influences cognitive decline across various domains.