Introduction:
Dementia is considered a multifocal decline that can interfere with all aspects of a life and has an emotional impact on patient and caregivers. Just because dementia increase with age, it will be a huge concern for any medical system world wide. 
Mild cognitive impairment  is associated with, or caused by, any vascular any vascular pathology including strokes, large and small ‘silent’ brain infarcts, microscopic infarcts, white matter pathology, cerebral microbleeds, chronic hypoperfusion.
A few patients have been considered to have “reversible” dementias due to treatable conditions. 
To perform endoarterectomy in high risk carotid stenosis in patient with Mild cognitive impairmen,t is important in order to delay dementia.
Methods:
We  selected patient with mild cognitive impairment that we have seen in the emergency setting due to Tia or minor stroke, from july 1 2017 to February 2018.
We did neurological evaluation , neuroimaging  ultrasound and blood test to rule out  other conditions that may  be a cause of cognitive impairment.
Results:
Twelve (12) patients showed a carotid stenosis >70% according to NASCET criteria.
They all presented vulnerable carotid atherosclerotic plaque detected by duplex  ultrasonography.
We perfomermed MOCA test in order to identify executive disfunction and we referred patient to endoarterectomy
After 1 month follow up, all patients showed an improvement on MOCA test (2-3 points).
Conclusion:
Currently, the best way to prevent dementia is to prevent stroke. In a stroke setting, we are able to perform ultrasound  to identify large vessel disease  as a  cause  stroke.
This approach is helpful for clinicians also to assess  patients with cognitive impairment and may help identify those patients in whom timely intervention endoarterectomy may halt or reverse the cognitive decline.

Identification of a high risk carotid plaques By Duplex ultrasonography and endoarterectomy may delay cognitive impairment