Carotid atherosclerotic calcification characteristics relate to post‐stroke cognitive impairment: Neuroimaging / Optimal neuroimaging measures for early detection

Background Post‐stroke cognitive impairment (PSCI) is one of the major complications during the chronic stage of ischemic stroke. Several factors, including age, education level, vascular risk factors, extent of stroke, and cerebral small vessel disease, are considered to be main determinants of PSCI. However, the relationship between large vessel diseases and PSCI was less studied before. In this study, we aimed to investigate the association between different carotid atherosclerotic calcification characteristics and PSCI. Method A total of 128 patients with acute ischemic stroke admitted to Huashan Hospital from 2017 to 2018 were included consecutively in this study. All of them completed brain/neck CTA and cognitive function battery at follow‐up. The number, size, location of calcifications in bilateral intracranial/extracranial internal carotid arteries, and the presence of rim sign was recorded separately. Quantitative analysis of arterial stenosis, reconstruction coefficient (RI) and soft plaque density was assessed as well. Cognitive function was evaluated 6‐12 months within the stroke onset. Post‐stroke cognitive impairment was diagnosed according to the cognitive questionnaires and CDR scale. Result In our study population, we found a prevalence of 58.6% for post‐stroke cognitive impairment with no dementia (PSCIND), and a prevalence of 20.3% for post‐stroke dementia (PSD). The presence of calcification on carotid arteries increased the risk for PSCI. Furthermore, in different calcification characteristics, multiple calcifications, thick/mixed calcifications and surface calcifications were significantly associated with PSCI after full adjustment (demographics, vascular risk factors and stroke severity). Carotid artery stenosis was another strong predictor for PSCI. However, rim sign, RI and soft plaque density showed no significant relationship with PSCI. Conclusion The quantity and location of calcification might be independent indicators for PSCI in carotid atherosclerotic plaques.