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We investigated the associations of carotid plaque burden and hemodynamic markers with cognitive impairment in 100 community-dwelling Egyptian adults aged\u2009\u2265\u200960 years without prior neurological disease. Carotid plaque burden was quantified by duplex ultrasound using plaque score, and cognition was assessed using the Montreal Cognitive Assessment (MoCA). Sixty-one Participants with a MoCA score\u2009\u2264\u200925 were classified as having possible mild cognitive impairment (MCI). Carotid plaques were detected in 53 participants, and plaque scores were higher in participants with possible MCI (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.035). Internal carotid artery resistive index (ICA RI) was also higher (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.011) among participants with possible MCI. In two separate multivariable models, plaque score (OR 1.41, 95% CI 1.06\u20131.86;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.020) and ICA RI (OR 1.87, 95% CI 1.01\u20133.46;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.046) were independently associated with possible MCI. Lower educational attainment showed the strongest association in both models. Plaque burden was most strongly associated with visuospatial and language performance. This cross-sectional study supports further longitudinal studies to determine whether carotid ultrasound markers predict subsequent cognitive decline.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-66871-w","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T08:55:06Z","timestamp":1787388906000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Carotid plaque burden and hemodynamic alterations are associated with domain-specific cognitive impairment in community-dwelling older adults"],"prefix":"10.1038","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9800-7830","authenticated-orcid":false,"given":"Ahmed","family":"Elhfnawy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3056-8038","authenticated-orcid":false,"given":"Mohamed Saud","family":"Kishk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8667-8514","authenticated-orcid":false,"given":"Hany","family":"El Deeb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1867-0136","authenticated-orcid":false,"given":"Jaidaa","family":"Mekky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,22]]},"reference":[{"key":"66871_CR1","unstructured":"Johri, A. 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