Introduction

Carotid atherosclerosis is a major public health concern, with high prevalence among elderly adults1. Beyond its role in stroke and cardiovascular disease, carotid plaque burden is linked to cognitive decline, even without overt cerebrovascular events2. Mild cognitive impairment (MCI), often preceding dementia, affects many older adults3, with dementia affecting tens of millions worldwide, particularly in low- and middle-income countries4. Many cross-sectional studies and meta-analyses indicate that greater carotid intima-media thickness (IMT) or plaque burden is associated with poorer global cognition and impairments in domains such as executive function and processing speed. However, longitudinal evidence remains heterogeneous: while some cohorts identify baseline IMT or composite plaque indices as predictors of subsequent cognitive decline, others report that plaque presence or area is no longer independently associated after adjustment for age, education, and vascular risk factors5,6,7. Notably, data from multiethnic and non-Western populations remain limited, restricting the generalizability of existing findings. This pilot cross-sectional study examines whether extracranial carotid plaque burden and hemodynamic markers are associated with global and domain-specific cognitive performance in community-dwelling older adults, adjusting for demographic and vascular risk factors.