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Prevalence and risk factors of cerebral microbleeds: the Rotterdam Scan Study
M W Vernooij1, A van der Lugt, M A Ikram
1Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands.
Background:
Cerebral microbleeds are focal deposits of hemosiderin that can be visualized with MRI. Little is known on their prevalence in the general population and on their etiology. It has been suggested that, in analogy to spontaneous intracranial hemorrhage, the etiology of microbleeds differs according to their location in the brain, with lobar microbleeds being caused by cerebral amyloid angiopathy and deep or infratentorial microbleeds resulting from hypertension and atherosclerosis. We investigated the prevalence of and risk factors for microbleeds in the general population aged 60 years and older.
Methods:
This study is based on 1,062 persons (mean age 69.6 years) from the population-based Rotterdam Scan Study. MRI was performed at 1.5 T and included a sequence optimized to increase the conspicuity of microbleeds. We assessed the relation of APOE genotype, cardiovascular risk factors, and markers of small vessel disease to the presence and location of microbleeds with multiple logistic regression.
Results:
Overall prevalence of cerebral microbleeds was high and increased with age from 17.8% in persons aged 60-69 years to 38.3% in those over 80 years. APOE epsilon 4 carriers had significantly more often strictly lobar microbleeds than noncarriers. In contrast, cardiovascular risk factors and presence of lacunar infarcts and white matter lesions were associated with microbleeds in a deep or infratentorial location but not in a lobar location.
Conclusion:
The prevalence of cerebral microbleeds is high. Our data support the hypothesis that strictly lobar microbleeds are related to cerebral amyloid angiopathy, whereas microbleeds in a deep or infratentorial location result from hypertensive or atherosclerotic microangiopathy.
Insights
Cerebral microbleeds are common in older adults, with lobar types linked to amyloid angiopathy and deep ones to hypertension. This study explored their prevalence and risk factors in individuals over 60.
Area of Science:
- Neurology
- Radiology
- Epidemiology
Background:
- Cerebral microbleeds, visualized by MRI, are hemosiderin deposits with unknown prevalence and etiology in the general population.
- Hypothesized differing causes for lobar (cerebral amyloid angiopathy) versus deep/infratentorial (hypertension, atherosclerosis) microbleeds.
Purpose of the Study:
- Investigate the prevalence of cerebral microbleeds in individuals aged 60 and older.
- Identify risk factors associated with microbleed presence and location.
Main Methods:
- Utilized MRI on 1,062 participants (mean age 69.6) from the Rotterdam Scan Study.
- Assessed associations between APOE genotype, cardiovascular risk factors, small vessel disease markers, and microbleed presence/location via logistic regression.
Main Results:
- High overall prevalence of cerebral microbleeds, increasing with age (17.8% in 60-69 yrs to 38.3% in >80 yrs).
- APOE epsilon 4 carriers showed more lobar microbleeds.
- Cardiovascular risk factors and markers of small vessel disease (lacunar infarcts, white matter lesions) correlated with deep/infratentorial microbleeds, not lobar ones.
Conclusions:
- Cerebral microbleed prevalence is substantial in the elderly population.
- Findings support distinct etiologies: lobar microbleeds linked to cerebral amyloid angiopathy, and deep/infratentorial microbleeds to hypertensive/atherosclerotic microangiopathy.
