Carotid- intima media thickness is independently associated with cognitive decline. The INVADE study y K. Sander 1,4 , H. Bickel 2 , H. Fo ¨rstl 2 , T. Etgen 2,5 , C. Briesenick 3 , H. Poppert 1 and D. Sander 1,4 1 Department of Neurology, Technical University, Munich, Germany 2 Department of Psychiatry and Psychotherapy, Technical University, Munich, Germany 3 INVADE Study Group, Baldham, Germany 4 Department of Neurology, Medical Park Hospital, Bischofswiesen, Germany 5 Department of Neurology, Klinikum Traunstein, Germany Correspondence to: K. Sander, MD, E-mail: ksander1@mac.com y The authors declare no conflict of interest. Objectives: Increased carotid intima-media thickness (C-IMT) is a non-invasive marker of atherosclero- sis and predicts vascular events. Moreover, increasing evidence suggests an association between carotid atherosclerosis and cognitive decline. The purpose of this study is to investigate the relationship between C-IMT and the development of cognitive impairment in a large population-based sample. Methods: This study was based on the data of the participants of the INVADE (Intervention project on cerebrovascular diseases and dementia in the district of Ebersberg, Bavaria) project. Vascular risk factors, Geriatric depression scale (GDS) and ‘‘6 Item Cognitive Impairment Test’’ (6CIT) were evaluated at baseline and after 2 years. The relationship between C-IMT and cognitive impairment was analysed using multivariate logistic regression. Results: Complete baseline data were available in 3386 subjects (mean age 67.7 [95% confidence interval (CI): 67.5, 68.0] years, 41% male). During follow-up, 174 subjects developed a new cognitive impair- ment. In the subgroup without cognitive impairment at baseline a significant association between cognitive decline after 2 years and elevated C-IMT at baseline could be detected with a significantly higher baseline C-IMT in those with cognitive decline (0.87 mm vs. 0.78 mm; p < 0.0001). After adjustment for various risk factors only age, GDS baseline 6CIT and C-IMT were independently associated with the development of a new cognitive impairment. Conclusions: Our data indicate that an increased carotid intima-media thickness predicts a cognitive decline in an elderly population without prevalent cognitive impairment. Copyright # 2009 John Wiley & Sons, Ltd. Key words: cognition; atherosclerosis; carotid duplexsonography; clinical neurology History: Received 23 February 2009; Accepted 4 June 2009; Published online 14 September 2009 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/gps.2351 Introduction Increased carotid intima-media thickness (C-IMT) is a non-invasive marker of subclinical atherosclerosis and predicts further vascular events. (Bots et al., 1997; Lorenz et al., 2007) Moreover, increased carotid IMT and/or carotid stenosis is a risk factor for cognitive impairment and poorer neuropsychological status in the elderly (de la Torre, 2004, Mathiesen et al., 2004; Haley et al., 2007; Komulainen et al., 2007) and stroke patients. (Talelli et al., 2004) Recently, van Oijen et al. (2007) described a strong association between C-IMT and the risk of dementia after a follow-up of 9 years. In our study we evaluated the relationship between C- IMT and the 2-year risk of cognitive impairment after adjustment for baseline age, gender, the depression, education, physical activity and various vascular risk factors in a population-based sample of the INVADE (Intervention project on cerebrovascular diseases and dementia in the district of Ebersberg, Bavaria) study. RESEARCH ARTICLE Copyright # 2009 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry 2010; 25: 389–394.