{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T10:11:22Z","timestamp":1790244682391,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Kaohsiung J of Med Scie"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Mild behavioral impairment (MBI) is a late\u2010life neuropsychiatric syndrome proposed as an early clinical manifestation of neurodegenerative disease. Vascular pathology contributes to late\u2010life cognitive and behavioral changes; however, its relationship with MBI remains insufficiently characterized. This cross\u2010sectional study investigated whether structural carotid atherosclerosis is associated with MBI and its symptom domains in 563 community\u2010dwelling, dementia\u2010free adults aged \u2265\u200950 from the Kaohsiung Atherosclerosis Longitudinal Study between 2018 and 2021. MBI was assessed using the informant\u2010rated Mild Behavioral Impairment Checklist, evaluating apathy\/motivation, affective dysregulation, impulse dyscontrol, social inappropriateness, and abnormal thought\/perception. Structural carotid atherosclerosis was evaluated by ultrasound, assessing plaques and mean carotid intima\u2013media thickness (cIMT) across the common carotid artery (CCA), bifurcation, and internal carotid artery. Advanced structural atherosclerosis was defined as the presence of plaque or top\u2010quartile cIMT. Multivariable regression models examined associations between carotid atherosclerosis and MBI severity, adjusting for demographics, medical conditions, and global cognition. Advanced structural atherosclerosis was independently associated with higher MBI scores (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009=\u20090.143,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.001). Elevated cIMT\u2014but not plaque\u2014was significantly associated with MBI severity. Segment\u2010specific analyses showed increased CCA IMT was the only vascular marker significantly related to MBI total scores. Furthermore, advanced structural atherosclerosis was associated with increased odds of decreased motivation, impulse dyscontrol, and social inappropriateness. In conclusion, structural carotid atherosclerosis, particularly elevated CCA IMT, is associated with greater MBI symptom burden in middle\u2010to\u2010older adults. Subclinical vascular pathology may contribute to early neurobehavioral changes, highlighting the importance of vascular health in identifying individuals at risk for neurodegenerative disorders.\n                  <\/jats:p>","DOI":"10.1002\/kjm2.70297","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:48:05Z","timestamp":1790243285000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Structural Carotid Atherosclerosis and Mild Behavioral Impairment: A Cross\u2010Sectional Study in a Community\u2010Dwelling Population"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8902-6668","authenticated-orcid":false,"given":"Po\u2010Han","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Psychiatry Kaohsiung Medical University Gangshan Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Psychiatry Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5778-8699","authenticated-orcid":false,"given":"Yi\u2010Ya","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung City Taiwan"},{"name":"Graduate Institute of Clinical Medicine College of Medicine, Kaohsiung Medical University  Kaohsiung City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen\u2010Ju","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung City Taiwan"},{"name":"Graduate Institute of Medicine College of Medicine, Kaohsiung Medical University  Kaohsiung City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2302-2961","authenticated-orcid":false,"given":"Mei\u2010Feng","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung City Taiwan"},{"name":"Department of Psychiatry, School of Medicine, College of Medicine Kaohsiung Medical University  Kaohsiung City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6400-0905","authenticated-orcid":false,"given":"Yi\u2010Chun","family":"Yeh","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung City Taiwan"},{"name":"Department of Psychiatry, School of Medicine, College of Medicine Kaohsiung Medical University  Kaohsiung City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6343-826X","authenticated-orcid":false,"given":"Hsiu\u2010Fen","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurology Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung City Taiwan"},{"name":"Department of Neurology, School of Medicine, College of Medicine Kaohsiung Medical University  Kaohsiung City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3860-8834","authenticated-orcid":false,"given":"Cheng\u2010Sheng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung City Taiwan"},{"name":"Department of Psychiatry, School of Medicine, College of Medicine Kaohsiung Medical University  Kaohsiung City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"issue":"6","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/S1474-4422(21)00066-1","article-title":"Clinical Diagnosis of Alzheimer's Disease: Recommendations of the International Working Group","volume":"20","author":"Dubois B.","year":"2021","journal-title":"Lancet Neurology"},{"issue":"10452","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/S0140-6736(24)01296-0","article-title":"Dementia Prevention, Intervention, and Care: 2024 Report of the Lancet Standing Commission","volume":"404","author":"Livingston G.","year":"2024","journal-title":"Lancet"},{"issue":"9","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1111\/j.1532-5415.1996.tb02942.x","article-title":"The Evolution of Psychiatric Symptoms in Alzheimer's Disease: A Natural History Study","volume":"44","author":"Jost B. 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