{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:15:48Z","timestamp":1783296948748,"version":"3.54.6"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Hypertens Res"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Increased stiffness in the proximal aorta and carotid artery, both crucial for regulating blood pressure and flow pulsatility, may contribute to cerebral microcirculation damage and cognitive decline. While aortic stiffness measured by aortic characteristic impedance (Zc) has been linked to suspected mild cognitive impairment (MCI), the role of carotid stiffness remains unclear due to inconsistent findings using traditional distensibility measures. This study investigates the relationship between carotid characteristic impedance (CCI) and suspected MCI, and examines how CCI interacts with Zc in contributing to cognitive dysfunction. A total of 1423 healthy community residents (average age 59.8\u2009\u00b1\u200911.7 years; 46.9% male) underwent comprehensive hemodynamic evaluations and carotid ultrasonography. CCI and Zc were calculated in the time domain, and the characteristic impedance ratio (CIR), defined as CCI\/Zc, was used to assess the influence of impedance mismatch. Suspected MCI was determined using education-adjusted Mini-Mental State Examination (MMSE) cut-offs. Among participants, 478 (33.6%) were identified with suspected MCI. These individuals showed significantly higher CCI, while other carotid distensibility parameters were not significantly different. CCI was the only carotid stiffness measure independently associated with suspected MCI (OR per SD: 1.18; 95% CI: 1.02\u20131.36). CIR was negatively associated with MCI (OR: 0.84; 95% CI: 0.73\u20130.95), suggesting that a mismatch in impedance contributes to cognitive decline. The combination of elevated Zc and CCI was the strongest predictor of suspected MCI (OR: 2.10; 95% CI: 1.47\u20132.98). These findings underscore CCI as a sensitive and valuable marker for assessing carotid stiffness in relation to cognitive dysfunction.<\/jats:p>","DOI":"10.1038\/s41440-026-02650-4","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T07:52:09Z","timestamp":1777276329000},"page":"2026-2037","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Role of characteristic impedance in carotid stiffness and cognitive dysfunction: interaction with proximal aortic stiffness"],"prefix":"10.1038","volume":"49","author":[{"given":"Chao-Feng","family":"Liao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao-Min","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen-Huan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao-Yuan","family":"Chuang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"2650_CR1","first-page":"A34","volume":"3","author":"DP Chapman","year":"2006","unstructured":"Chapman DP, Williams SM, Strine TW, Anda RF, Moore MJ. Dementia and its implications for public health. Prev Chronic Dis. 2006;3:A34.","journal-title":"Prev Chronic Dis"},{"key":"2650_CR2","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1016\/j.neurobiolaging.2019.02.030","volume":"89","author":"VK Venkatraman","year":"2020","unstructured":"Venkatraman VK, Sanderson A, Cox KL, Ellis KA, Steward C, Phal PM, et al. Effect of a 24-month physical activity program on brain changes in older adults at risk of Alzheimer\u2019s disease: the AIBL active trial. Neurobiol Aging. 2020;89:132\u201341.","journal-title":"Neurobiol Aging"},{"key":"2650_CR3","first-page":"48","volume":"2","author":"GM London","year":"1997","unstructured":"London GM. Large arteries haemodynamics: conduit versus cushioning function. Blood Press Suppl. 1997;2:48\u201351.","journal-title":"Blood Press Suppl"},{"key":"2650_CR4","doi-asserted-by":"publisher","first-page":"1379","DOI":"10.1161\/CIRCULATIONAHA.109.914507","volume":"122","author":"GF Mitchell","year":"2010","unstructured":"Mitchell GF, Wang N, Palmisano JN, Larson MG, Hamburg NM, Vita JA, et al. Hemodynamic correlates of blood pressure across the adult age spectrum: noninvasive evaluation in the Framingham Heart Study. Circulation. 2010;122:1379\u201386.","journal-title":"Circulation"},{"key":"2650_CR5","first-page":"215","volume":"6","author":"P Basu","year":"2010","unstructured":"Basu P, Sen U, Tyagi N, Tyagi SC. Blood flow interplays with elastin: collagen and MMP: TIMP ratios to maintain healthy vascular structure and function. Vasc Health Risk Manag. 2010;6:215\u201328.","journal-title":"Vasc Health Risk Manag"},{"key":"2650_CR6","doi-asserted-by":"publisher","first-page":"1652","DOI":"10.1152\/japplphysiol.90549.2008","volume":"105","author":"GF Mitchell","year":"2008","unstructured":"Mitchell GF. Effects of central arterial aging on the structure and function of the peripheral vasculature: implications for end-organ damage. J Appl Physiol. 2008;105:1652\u201360.","journal-title":"J Appl Physiol"},{"key":"2650_CR7","doi-asserted-by":"publisher","first-page":"3398","DOI":"10.1093\/brain\/awr253","volume":"134","author":"GF Mitchell","year":"2011","unstructured":"Mitchell GF, van Buchem MA, Sigurdsson S, Gotal JD, Jonsdottir MK, Kjartansson O, et al. Arterial stiffness, pressure and flow pulsatility and brain structure and function: the age, gene\/environment susceptibility-Reykjavik study. Brain. 2011;134:3398\u2013407.","journal-title":"Brain"},{"key":"2650_CR8","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1016\/j.jacc.2019.07.012","volume":"74","author":"JA Chirinos","year":"2019","unstructured":"Chirinos JA, Segers P, Hughes T, Townsend R. Large-artery stiffness in health and disease: JACC state-of-the-art review. J Am Coll Cardiol. 2019;74:1237\u201363.","journal-title":"J Am Coll Cardiol"},{"key":"2650_CR9","doi-asserted-by":"crossref","unstructured":"Liao CF, Chuang SY, Cheng HM, Lin CH, Chen CH. Aortic characteristic impedance and suspected mild cognitive impairment in a community-based healthy population. J Am Heart Assoc. 2023;13:e032268.","DOI":"10.1161\/JAHA.123.032268"},{"key":"2650_CR10","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1161\/01.STR.0000257998.33768.87","volume":"38","author":"MM Poels","year":"2007","unstructured":"Poels MM, van Oijen M, Mattace-Raso FU, Hofman A, Koudstaal PJ, Witteman JC, et al. Arterial stiffness, cognitive decline, and risk of dementia: the Rotterdam study. Stroke. 2007;38:888\u201392.","journal-title":"Stroke"},{"key":"2650_CR11","doi-asserted-by":"publisher","first-page":"2400","DOI":"10.1097\/HJH.0b013e328364decc","volume":"31","author":"T Tarumi","year":"2013","unstructured":"Tarumi T, Gonzales MM, Fallow B, Nualnim N, Pyron M, Tanaka H, et al. Central artery stiffness, neuropsychological function, and cerebral perfusion in sedentary and endurance-trained middle-aged adults. J Hypertens. 2013;31:2400\u20139.","journal-title":"J Hypertens"},{"key":"2650_CR12","doi-asserted-by":"publisher","first-page":"1607","DOI":"10.1161\/HYPERTENSIONAHA.119.14307","volume":"75","author":"SP Rensma","year":"2020","unstructured":"Rensma SP, Stehouwer CDA, Van Boxtel MPJ, Houben A, Berendschot T, Jansen JFA, et al. Associations of arterial stiffness with cognitive performance, and the role of microvascular dysfunction: the Maastricht study. Hypertension. 2020;75:1607\u201314.","journal-title":"Hypertension"},{"key":"2650_CR13","doi-asserted-by":"publisher","first-page":"2886","DOI":"10.2337\/dc07-0191","volume":"30","author":"NK Sweitzer","year":"2007","unstructured":"Sweitzer NK, Shenoy M, Stein JH, Keles S, Palta M, LeCaire T, et al. Increases in central aortic impedance precede alterations in arterial stiffness measures in type 1 diabetes. Diabetes Care. 2007;30:2886\u201391.","journal-title":"Diabetes Care"},{"key":"2650_CR14","doi-asserted-by":"publisher","first-page":"1433","DOI":"10.1161\/hy1201.098298","volume":"38","author":"GF Mitchell","year":"2001","unstructured":"Mitchell GF, Tardif JC, Arnold JM, Marchiori G, O\u2019Brien TX, Dunlap ME, et al. Pulsatile hemodynamics in congestive heart failure. Hypertension. 2001;38:1433\u20139.","journal-title":"Hypertension"},{"key":"2650_CR15","first-page":"668","volume":"100","author":"CJ Yeh","year":"2001","unstructured":"Yeh CJ, Pan WH, Jong YS, Kuo YY, Lo CH. Incidence and predictors of isolated systolic hypertension and isolated diastolic hypertension in Taiwan. J Formos Med Assoc. 2001;100:668\u201375.","journal-title":"J Formos Med Assoc"},{"key":"2650_CR16","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.844396","volume":"9","author":"HM Cheng","year":"2022","unstructured":"Cheng HM, Chuang SY, Ko YT, Liao CF, Pan WH, Liu WL, et al. Education level may modify the association between cardiac index and cognitive function among elders with normal ejection function. Front Cardiovasc Med. 2022;9:844396.","journal-title":"Front Cardiovasc Med"},{"key":"2650_CR17","first-page":"693","volume":"64","author":"YP Lin","year":"2001","unstructured":"Lin YP, Chen CH, Hsu TL, Yang WC, Ding PY. Sequential tonometry as a practical method to estimate truncal pulse wave velocity. Zhonghua Yi Xue Za Zhi. 2001;64:693\u2013702.","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"2650_CR18","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1161\/HYPERTENSIONAHA.109.139964","volume":"55","author":"KL Wang","year":"2010","unstructured":"Wang KL, Cheng HM, Sung SH, Chuang SY, Li CH, Spurgeon HA, et al. Wave reflection and arterial stiffness in the prediction of 15-year all-cause and cardiovascular mortalities: a community-based study. Hypertension. 2010;55:799\u2013805.","journal-title":"Hypertension"},{"key":"2650_CR19","doi-asserted-by":"publisher","first-page":"1719","DOI":"10.1093\/eurheartj\/eht565","volume":"35","author":"CM McEniery","year":"2014","unstructured":"McEniery CM, Cockcroft JR, Roman MJ, Franklin SS, Wilkinson IB. Central blood pressure: current evidence and clinical importance. Eur Heart J. 2014;35:1719\u201325.","journal-title":"Eur Heart J"},{"key":"2650_CR20","doi-asserted-by":"publisher","first-page":"1776","DOI":"10.1097\/HJH.0000000000003217","volume":"40","author":"CH Lin","year":"2022","unstructured":"Lin CH, Cheng HM, Wang JJ, Peng LN, Chen LK, Wang PN, et al. Excess pressure but not pulse wave velocity is associated with cognitive function impairment: a community-based study. J Hypertens. 2022;40:1776\u201385.","journal-title":"J Hypertens"},{"key":"2650_CR21","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.1161\/01.STR.24.9.1297","volume":"24","author":"G Howard","year":"1993","unstructured":"Howard G, Sharrett AR, Heiss G, Evans GW, Chambless LE, Riley WA, et al. Carotid artery intimal-medial thickness distribution in general populations as evaluated by B-mode ultrasound. ARIC Investigators. Stroke. 1993;24:1297\u2013304.","journal-title":"Stroke"},{"key":"2650_CR22","doi-asserted-by":"publisher","first-page":"1338","DOI":"10.1161\/STROKEAHA.110.605477","volume":"42","author":"SY Chuang","year":"2011","unstructured":"Chuang SY, Bai CH, Chen JR, Yeh WT, Chen HJ, Chiu HC, et al. Common carotid end-diastolic velocity and intima-media thickness jointly predict ischemic stroke in Taiwan. Stroke. 2011;42:1338\u201344.","journal-title":"Stroke"},{"key":"2650_CR23","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1093\/eurheartj\/ehi177","volume":"26","author":"RS Reneman","year":"2005","unstructured":"Reneman RS, Meinders JM, Hoeks APG. Non-invasive ultrasound in arterial wall dynamics in humans: what have we learned and what remains to be solved. Eur Heart J. 2005;26:960\u20136.","journal-title":"Eur Heart J"},{"key":"2650_CR24","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","volume":"12","author":"MF Folstein","year":"1975","unstructured":"Folstein MF, Folstein SE, McHugh PR. \u201cMini-Mental State\u201d. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189\u201398.","journal-title":"J Psychiatr Res"},{"key":"2650_CR25","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1097\/01.JGP.0000235710.17450.9a","volume":"15","author":"TP Ng","year":"2007","unstructured":"Ng TP, Niti M, Chiam PC, Kua EH. Ethnic and educational differences in cognitive test performance on mini-mental state examination in Asians. Am J Geriatr Psychiatry. 2007;15:130\u20139.","journal-title":"Am J Geriatr Psychiatry"},{"key":"2650_CR26","first-page":"458","volume":"53","author":"L Feng","year":"2012","unstructured":"Feng L, Chong MS, Lim WS, Ng TP. The Modified Mini-Mental State Examination test: normative data for Singapore Chinese older adults and its performance in detecting early cognitive impairment. Singap Med J. 2012;53:458\u201362.","journal-title":"Singap Med J"},{"key":"2650_CR27","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.014862","volume":"9","author":"KF Hoth","year":"2020","unstructured":"Hoth KF, Moreau KL, Weinberger HD, Holm KE, Meschede K, Crapo JD, et al. Carotid artery stiffness is associated with cognitive performance in former smokers with and without chronic obstructive pulmonary disease. J Am Heart Assoc. 2020;9:e014862.","journal-title":"J Am Heart Assoc"},{"key":"2650_CR28","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1212\/WNL.0b013e318281ccc2","volume":"80","author":"M Brisset","year":"2013","unstructured":"Brisset M, Boutouyrie P, Pico F, Zhu Y, Zureik M, Schilling S, et al. Large-vessel correlates of cerebral small-vessel disease. Neurology. 2013;80:662\u20139.","journal-title":"Neurology"},{"key":"2650_CR29","doi-asserted-by":"publisher","first-page":"27","DOI":"10.3233\/JAD-150516","volume":"50","author":"SL Lim","year":"2016","unstructured":"Lim SL, Gao Q, Nyunt MS, Gong L, Lunaria JB, Lim ML, et al. Vascular health indices and cognitive domain function: Singapore Longitudinal Aging Studies. J Alzheimers Dis. 2016;50:27\u201340.","journal-title":"J Alzheimers Dis"},{"key":"2650_CR30","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1016\/j.atherosclerosis.2016.07.912","volume":"253","author":"SL Geijselaers","year":"2016","unstructured":"Geijselaers SL, Sep SJ, Schram MT, van Boxtel MP, van Sloten TT, Henry RM, et al. Carotid stiffness is associated with impairment of cognitive performance in individuals with and without type 2 diabetes. The Maastricht Study. Atherosclerosis. 2016;253:186\u201393.","journal-title":"Atherosclerosis"},{"key":"2650_CR31","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.852173","volume":"9","author":"H Baradaran","year":"2022","unstructured":"Baradaran H, Gupta A. Carotid artery stiffness: imaging techniques and impact on cerebrovascular disease. Front Cardiovasc Med. 2022;9:852173.","journal-title":"Front Cardiovasc Med"},{"key":"2650_CR32","doi-asserted-by":"publisher","first-page":"46","DOI":"10.33963\/KP.15642","volume":"79","author":"J Baran","year":"2021","unstructured":"Baran J, Przewlocki T, Podolec J, Gryglicka K, Badacz R, Gackowski A, et al. Assessment of the Willis circle flow changes and the severity of degenerative aortic stenosis and cognitive impairment. Kardiol Pol. 2021;79:46\u201352.","journal-title":"Kardiol Pol"},{"key":"2650_CR33","doi-asserted-by":"publisher","first-page":"e1248","DOI":"10.1212\/WNL.0000000000005259","volume":"90","author":"TM Hughes","year":"2018","unstructured":"Hughes TM, Wagenknecht LE, Craft S, Mintz A, Heiss G, Palta P, et al. Arterial stiffness and dementia pathology: Atherosclerosis Risk in Communities (ARIC)-PET Study. Neurology. 2018;90:e1248\u2013e56.","journal-title":"Neurology"},{"key":"2650_CR34","doi-asserted-by":"publisher","first-page":"925","DOI":"10.3233\/JAD-191073","volume":"74","author":"EP Pasha","year":"2020","unstructured":"Pasha EP, Rutjes E, Tomoto T, Tarumi T, Stowe A, Claassen J, et al. Carotid stiffness is associated with brain amyloid-beta burden in amnestic mild cognitive impairment. J Alzheimers Dis. 2020;74:925\u201335.","journal-title":"J Alzheimers Dis"},{"key":"2650_CR35","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1161\/HYPERTENSIONAHA.109.141275","volume":"55","author":"A Redheuil","year":"2010","unstructured":"Redheuil A, Yu WC, Wu CO, Mousseaux E, de Cesare A, Yan R, et al. Reduced ascending aortic strain and distensibility: earliest manifestations of vascular aging in humans. Hypertension. 2010;55:319\u201326.","journal-title":"Hypertension"},{"key":"2650_CR36","doi-asserted-by":"publisher","first-page":"2672","DOI":"10.1161\/STR.0b013e3182299496","volume":"42","author":"PB Gorelick","year":"2011","unstructured":"Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association\/American Stroke Association. Stroke. 2011;42:2672\u2013713.","journal-title":"Stroke"},{"key":"2650_CR37","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1007\/s00380-011-0229-y","volume":"28","author":"Y Oishi","year":"2013","unstructured":"Oishi Y, Miyoshi H, Iuchi A, Nagase N, Ara N, Oki T. Vascular aging of common carotid artery and abdominal aorta in clinically normal individuals and preclinical patients with cardiovascular risk factors: diagnostic value of two-dimensional speckle-tracking echocardiography. Heart Vessels. 2013;28:222\u20138.","journal-title":"Heart Vessels"},{"key":"2650_CR38","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1177\/0271678X241281137","volume":"45","author":"C Robert","year":"2025","unstructured":"Robert C, Ling LH, Tan ES, Venketasubramanian N, Lim SL, Gong L, et al. The relative associations of aortic and carotid artery stiffness with CeVD and cognition. J Cereb Blood Flow Metab. 2025;45:498\u2013509.","journal-title":"J Cereb Blood Flow Metab"}],"container-title":["Hypertension Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41440-026-02650-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41440-026-02650-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41440-026-02650-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:03:57Z","timestamp":1783296237000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41440-026-02650-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,27]]},"references-count":38,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["2650"],"URL":"https:\/\/doi.org\/10.1038\/s41440-026-02650-4","relation":{},"ISSN":["0916-9636","1348-4214"],"issn-type":[{"value":"0916-9636","type":"print"},{"value":"1348-4214","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,27]]},"assertion":[{"value":"3 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 April 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 April 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 April 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}