Abstract Body: Background:
Worldwide prevalence of asymptomatic carotid stenosis (ACS) remains high, and its high implications include cognitive deterioration through multiple biological pathways. The understanding of this relationship is vital for informing clinical decision-making.
Objective:
This review aims to evaluate the impact of ACS on cognitive function in adult patients.
Methods:
This review followed PRISMA guidelines. Studies published from 2015 to 2025 were searched across PubMed/MEDLINE, EMBASE, Cochrane Library and Scopus databases. Eligible studies included adult participants who received ACS diagnosis through imaging and underwent neuropsychological assessment. Two reviewers independently screened the studies and extracted data. The Newcastle-Ottawa Scale evaluated observational studies while the Cochrane RoB2 tool evaluated randomised controlled trials for their quality.
Results:
This systematic review included forty studies which met the inclusion criteria and consisted of twenty-five cross-sectional studies, eight cohort studies, two case-control studies, two randomised controlled trials and two systematic reviews. ACS was consistently associated with reduced performance in global cognition, memory, and executive function. The neuroimaging results demonstrated brain structure changes including cortical thinning, grey matter reduction, and white matter hyperintensities, all of which correlated with declining cognitive function.
Conclusions:
ACS is associated with significant cognitive impairment affecting multiple cognitive domains. The association between carotid stenosis and cognitive decline seems to be mediated by cerebral hypoperfusion, grey and white matter changes, and silent strokes. The research findings support the need for routine cognitive screening for patients with ACS.