Severity of Intracranial Arterial Calcification on CT and Dementia Risk in Stroke or TIA

04 Mar 20265 min read0 viewsJournal Feed

GIST

Journal of the American Heart Association, Volume 15, Issue 6 , March 17, 2026. BackgroundCoronary arterial calcification predicts coronary events, but although intracranial arterial calcification on CT (CT‐IAC) is a frequent finding in older individuals, few longitudinal studies have assessed whether its severity or site predict dementia. We did a population‐based study in patients with transient ischemic attack (TIA) or stroke to assess these associations.MethodsIn a matched case–control study of patients with minor stroke/transient ischemic attack nested in the population‐based OXVASC (Oxford Vascular Study), severity (qualitatively and semiautomated 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).ResultsIn OXVASC (cases/controls=200/200; mean age=78.0±9.3 years), dementia was independently associated with severity of internal carotid artery CT‐IAC on visual assessment (bilateral severe—adjusted OR [aOR], 2.02 [95% CI, 1.26–3.23],P=0.004) and quantitative volume (top versus bottom tertile—aOR, 2.35 [95% CI, 1.33–4.16],P=0.003), driven mainly by individuals with very high calcification volumes (≥600 mm3versus 0–299 mm3—aOR, 6.23 [95% CI, 1.24–31.24],P=0.026).

Clinical Editorial

Study design and population

A population-based, nested case–control analysis within the Oxford Vascular Study (OXVASC) examined patients with minor stroke or transient ischemic attack.
The cohort comprised 200 cases who developed dementia on follow-up and 200 age- and sex-matched controls who did not, with a mean age of 78 years.

Imaging assessment and exposure definition

Intracranial arterial calcification on CT (CT-IAC) was evaluated for severity both qualitatively (visual assessment) and semiautomated volume measurements.
Calcification location was categorized as arterial intimal calcification or calcification involving the internal elastic lamina, with emphasis on internal carotid and vertebrobasilar territories.

Key findings on dementia risk associations

This association persisted after excluding recurrent stroke and in subgroups with moderate to severe white matter disease.

Dementia risk showed an independent association with the severity of internal carotid artery CT-IAC when assessed visually; bilateral severe burden carried a higher odds ratio compared with milder patterns.
Quantitative volume analysis demonstrated a stronger risk with higher calcification volumes, notably for the top versus bottom tertiles; very high volumes (≥600 mm3) were associated with markedly increased odds.
A similar pattern emerged when examining CT-IAC across the internal carotid artery and vertebrobasilar circulation combined, with top versus bottom tertile comparisons yielding elevated odds of dementia.
Within the internal carotid artery, calcification limited to the internal elastic lamina independently predicted dementia after adjustment for either qualitative severity or quantitative measures of CT-IAC.

Context and implications

The findings indicate that greater burden and specific sites of intracranial calcification correlate with later dementia in individuals with prior stroke or TIA.
The observed patterns suggest potential pathophysiological links between intracranial atherosclerotic calcification and neurodegenerative outcomes, though the precise mechanisms remain to be clarified in larger studies.

Limitations and uncertainties

The authors note that the extent of nonlinearity in the dose–response and possible differences by calcification subtype or dementia phenotype require confirmation in larger cohorts.