Vascular cognitive impairment (VCI) affects 20% to 40% of cardiovascular patients, yet early identification remains challenging. This retrospective study evaluated the predictive value of carotid ultrasound parameters for VCI in 412 patients with cardiovascular risk factors who underwent carotid ultrasound and cognitive assessment between January 2019 and December 2023. Patients were categorized into normal cognition (n = 156), mild cognitive impairment (n = 184), and vascular dementia (n = 72) based on Montreal Cognitive Assessment scores. Carotid intima-media thickness (cIMT) progressively increased from normal cognition (0.89 ± 0.15 mm) to vascular dementia (1.18 ± 0.24 mm, P < .001). After multivariable adjustment, cIMT >1.0 mm (Odds Ratio [OR]: 2.84, 95% CI: 1.76-4.58), carotid stenosis ≥50% (OR: 4.92, 95% CI: 2.31-10.47), and resistive index >0.75 (OR: 3.15, 95% CI: 1.89-5.24) were independently associated with VCI. A combined model incorporating multiple carotid parameters achieved an area under the curve of 0.82 for VCI detection. These findings suggest that carotid ultrasound parameters may help identify cardiovascular patients at elevated risk for cognitive impairment, though external validation is needed before clinical implementation.
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