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Carotid stiffness is associated with impairment of cognitive performance in individuals with and without type 2 diabetes. The Maastricht Study

Stefan L.C. Geijselaers, Simone J.S. Sep, Miranda T. Schram, Martin P.J. van Boxtel, Thomas T. van Sloten, Ronald M.A. Henry, Koen D. Reesink, Abraham A. Kroon, Annemarie Koster, Nicolaas C. Schaper, Pieter C. Dagnelie, Carla J.H. van der Kallen, Geert Jan Biessels, Coen D.A. Stehouwer


Background and aims

There is increasing evidence linking arterial (mainly aortic) stiffness and type 2 diabetes, a risk factor for arterial stiffness, to cognitive impairment and dementia. However, data on carotid stiffness, which may be especially relevant for cognitive performance, are scarce, and few studies have addressed the interplay between arterial stiffness, type 2 diabetes, and cognitive performance.


We studied individuals with (n = 197) and without (n = 528) type 2 diabetes, who completed a neuropsychological test battery and underwent applanation tonometry and vascular ultrasound to evaluate aortic (i.e. carotid-to-femoral pulse wave velocity) and carotid stiffness (i.e. distensibility, compliance and Young's elastic modulus). Linear regression analyses were performed and adjusted for demographics, vascular risk factors, and depression.


Overall, our results showed that carotid, but not aortic, stiffness was associated with worse cognitive performance, primarily in the domains of processing speed (standardized regression coefficient for distensibility −0.083, p = 0.040; compliance −0.077, p = 0.032) and executive function and attention (distensibility −0.133, p = 0.001; compliance −0.090, p = 0.015; Young's elastic modulus −0.081, p = 0.027). These associations did not differ by diabetes status. The differences in cognitive performance between individuals with and without type 2 diabetes (mean difference in domain scores relative to those without diabetes for free recall memory −0.23, processing speed −0.19, executive function and attention −0.23; all p ≤ 0.009 and adjusted for demographics, traditional vascular risk factors, and depression) were not substantially altered after additional adjustment for carotid stiffness.


Our findings suggest that carotid stiffness is associated with cognitive performance in both individuals with and without diabetes, but does not mediate the relationship between type 2 diabetes and cognitive dysfunction.

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