Advertisement

PROBABLE CAA AND CLINICAL IMPLICATIONS IN A LARGE MEMORY CLINIC COHORT

      Background

      Cerebral amyloid angiopathy (CAA) is associated with cognitive impairment, and especially with Alzheimer’s disease. CAA manifests as neuroimaging markers of small vessel disease, and a conspicuous marker for CAA is lobar cerebral microbleeds (CMBs). We aimed to study differences in patients with and without probable-CAA and cognitive impairment in a large memory clinic.

      Methods

      A total of 1504 patients undergoing memory investigation were recruited in our study. All patients underwent MR imaging with hemosiderin sensitive sequences and 1039 patients had cerebrospinal fluid (CSF) biomarker analysis. Probable-CAA was classified according to the Boston criteria using microbleeds as hemorrhagic markers. MR images were further analyzed for all markers of small vessel disease including superficial siderosis, white matter hyperintensities (WMH), lacunes and enlarged perivascular spaces. Generalized linear models with appropriate corrections were used to assess data.

      Results

      A total of 99 patients (46 Alzheimer disease, 27 mild cognitive impairment, 6 subjective cognitive impairment, 9 vascular dementia, and 11 with other diseases) were classified as having probable-CAA. Patients without probable-CAA had lower CSF amyloid β (Aβ) 42 levels (P<0.001); patients with probable-CAA had higher CSF/ serum albumin ratios, reflecting blood brain barrier dysfunction, (P=0.04), as well as a tendency for higher total tau and P-tau levels (P=0.05). Patients with probable CAA had significantly higher burden of WMH (OR: 2.7, 95CI: 1.6-4.5), cortical superficial siderosis (OR: 6.6, 95CI: 2.3-14.8), lacunes 2.2 (1.3-3.8), and significantly lower amount of deep CMBs (OR: 0.04, 95CI: 0.01 - 0.31). There was no difference in amount of enlarged perivascular spaces, as well as MMSE score between patients with and without probable-CAA.

      Conclusions

      Patients with cognitive impairment and probable-CAA likely have higher associated neurodegeneration with their disease, and a higher number of associated small vessel disease markers of CAA.