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Severity of Intracranial Arterial Calcification on Computed Tomography and Risk of Dementia in Patients With Stroke

Ke Li 李可¹, Davide Simonato¹, Peter M Rothwell¹

¹Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences University of Oxford Oxford UK.

Journal of the American Heart Association

|March 4, 2026

Insights

Intracranial arterial calcification severity predicts dementia risk in patients with stroke or transient ischemic attack (TIA). Higher calcification levels, particularly in the internal carotid artery, are associated with increased dementia likelihood.

Area of Science:

Neurology
Vascular Medicine
Radiology

Background:

Coronary arterial calcification is a known predictor of cardiovascular events.
Intracranial arterial calcification (CT-IAC) is common in older adults but its predictive value for dementia is understudied.
Longitudinal data on CT-IAC severity and location predicting dementia after stroke or transient ischemic attack (TIA) is limited.

Purpose of the Study:

To assess whether the severity and site of intracranial arterial calcification (CT-IAC) predict dementia development.
To investigate the association between CT-IAC and dementia in a population-based study of patients with TIA or stroke.

Main Methods:

A matched case-control study within the Oxford Vascular Study (OXVASC) population.
Compared CT-IAC severity (qualitative and quantitative volume) and location (intimal vs. internal elastic lamina) in patients who developed dementia versus matched controls.
Used logistic regression, adjusting for other vascular risk factors.

Main Results:

Dementia was independently associated with internal carotid artery CT-IAC severity (visual assessment and quantitative volume).
Very high calcification volumes (≥600 mm³) showed a significantly higher odds ratio for dementia.
CT-IAC in the internal carotid artery, specifically at the internal elastic lamina, independently predicted dementia.

Conclusions:

The severity of intracranial arterial calcification (CT-IAC) is an independent predictor of future dementia following stroke or TIA.
Further research in larger cohorts is needed to explore non-linear relationships and dementia subtype differences.

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Abstract

Background:

Coronary 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.

Methods:

In 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).

Results:

In 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 mm³ versus 0-299 mm³-aOR, 6.23 [95% CI, 1.24-31.24], P=0.026). Similar trends were observed for CT-IAC in the internal carotid artery and vertebrobasilar artery combined (top versus bottom tertile-aOR, 2.59[95% CI, 1.43-4.68], P=0.002), including after exclusion of recurrent stroke (aOR, 2.60 [95% CI, 1.33-5.08], P=0.005) and patients with moderate/severe white matter disease (aOR, 3.19 [95% CI, 1.54-6.62], P=0.002). Internal carotid artery CT-IAC of the internal elastic lamina independently predicted dementia after adjusting for qualitative (aOR, 1.84 [95% CI, 1.11-3.05, P=0.019) or quantitative (aOR, 1.78 [95% CI, 1.06-2.99], P=0.029) CT-IAC severity.

Conclusions:

Severity of CT-IAC independently predicts future dementia after stroke/ transient ischemic attack. The extent of any nonlinearity and calcification- or dementia-subtype differences should be determined in larger studies.

Keywords:

dementia intracranial arterial calcification stroke

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