Dementia incidence and predictors in cerebral amyloid angiopathy patients without intracerebral hemorrhage

Author:

Xiong Li1,Boulouis Gregoire1,Charidimou Andreas1,Roongpiboonsopit Duangnapa12,Jessel Michael J1,Pasi Marco1,Reijmer Yael D1,Fotiadis Panagiotis1,Ayres Alison1,Merrill Emily3,Schwab Kristin1,Blacker Deborah4,Gurol M Edip1,Greenberg Steven M1,Viswanathan Anand1

Affiliation:

1. Department of Neurology, Harvard Medical School, Boston, USA

2. Department of Medicine, Naresuan University, Phitsanulok, Thailand

3. MIND Informatics, Harvard Medical School, Boston, USA

4. Department of Psychiatry, Harvard Medical School, Boston, USA

Abstract

Cerebral amyloid angiopathy (CAA) is a common cause of cognitive impairment in older individuals. This study aimed to investigate predictors of dementia in CAA patients without intracerebral hemorrhage (ICH). A total of 158 non-demented patients from the Stroke Service or the Memory Clinic who met the modified Boston Criteria for probable CAA were included. At baseline, neuroimaging markers, including lobar microbleeds (cerebral microbleeds (CMBs)), white matter hyperintensities (WMH), cortical superficial siderosis (cSS), magnetic resonance imaging (MRI)-visible centrum semiovale perivascular spaces (CSO-PVS), lacunes, and medial temporal atrophy (MTA) were assessed. The overall burden of small vessel disease (SVD) for CAA was calculated by a cumulative score based on CMB number, WMH severity, cSS presence and extent and CSO-PVS severity. The estimated cumulative dementia incidence at 1 year was 14% (95% confidence interval (CI): 5%–23%), and 5 years 73% (95% CI: 55%, 84%). Age (hazard ratio (HR) 1.05 per year, 95% CI: 1.01–1.08, p = 0.007), presence of MCI status (HR 3.40, 95% CI: 1.97–6.92, p < 0.001), MTA (HR 1.71 per point, 95% CI: 1.26–2.32, p = 0.001), and SVD score (HR 1.23 per point, 95% CI: 1.20–1.48, p = 0.030) at baseline were independent predictors for dementia conversion in these patients. Cognitive deterioration of CAA patients appears attributable to cumulative changes, from both vasculopathic and neurodegenerative lesions.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Clinical Neurology,Neurology

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