ABSTRACT: Background: Previously, we reported on vascular cognitive impairment (VCI) templates, consisting of patients with VCI associated with carotid stenosis (>60%) using a quantitative electroencephalographic (EEG) technique called neuronal activity topography (NAT). Here using the VCI templates, we investigated the hypothesis that internal carotid artery-intima-media thickness (ICA-IMT) is associated with EEG spectrum intensity (sNAT) and spectrum steepness (vNAT). Methods: A total of 221 community-dwelling elderly subjects were recruited. Four groups were classified according to quartiles of ICA-IMT as assessed by ultrasonography: control group A, normal (?0.9 mm); group B, mild atherosclerosis (1-1.1 mm); group C, moderate atherosclerosis (1.2-1.8 mm); and group D, severe atherosclerosis (?1.9 mm). EEG markers of power ratio index (PRI), and the binary likelihood of being in the VCI group vs. the that of being in control group A (sL x:VCI-A , vL x:VCI-A ) were assessed, respectively. Differences in mean total scores for PRI, sL x:VCI-A , vL x:VCI-A , between control group A and the other groups were compared using Dunnett's test, respectively. Results: The mean total scores of the PRI were 3.25, 3.00, 2.77, and 2.26 for groups A, B, C, and D, respectively. There was a significant decrease in the PRI in group D compared with group A (P = 0.0066). The mean total scores of the sL x:VCI-A were -0.14, -0.11, -0.1, and -0.03 for groups A, B, C, and D, respectively. The sL x:VCI-A in group D was significantly higher compared to that in group A (P < 0.0001). The mean total scores of the vL x:VCI-A were -0.04,-0.01, 0.01, and 0.06 for group A, B, C, and D, respectively. The vL x:VCI-A in group D and group C was significantly higher compared to that in group A, respectively (P < 0.0001, P = 0.02). Conclusion: Community-dwelling elderly subjects in the increased carotid atherosclerosis of ICA-IMT (?1.9 mm) were at greatest risk of an EEG change as assessed by NAT.