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Published on: April 23, 2021
Incidence of cerebral microbleeds: a longitudinal study in a memory clinic population
J D C Goos1, W J P Henneman, J D Sluimer
1Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands. j.goos@vumc.nl
Background:
Cerebral microbleeds (MBs) are commonly observed in memory clinic patients. Little is known about occurrence of and risk factors for developing new MBs in this population.
Objective:
To investigate incidence of lobar and nonlobar MBs in a memory clinic population. Furthermore, to assess risk factors for the development of new MBs and their associations with other MRI changes.
Methods:
A total of 254 patients visiting our memory clinic, with repeat gradient-recalled echo T2*-weighted MRI, were included (scan interval 1.9 +/- 0.9 years). Baseline and incident MBs were regionally counted. White matter hyperintensities (WMH) and progression of WMH were assessed using visual rating scales. Baseline brain volume and whole-brain atrophy rate were estimated automatically. In a subset, APOE was determined.
Results:
Thirty-one (12%) patients developed new MBs (range 1-19). Both multiple strictly lobar and nonlobar MBs at baseline predicted incident MBs (odds ratio [OR] 8.4; 95% confidence interval [CI] 2.2-33.2, and OR 33.8; 95% CI 8.1-140.8). Furthermore, baseline WMH grade (OR 1.2; 1.1-1.3), lacunar infarcts (OR 2.8; 1.3-6.0), and APOE epsilon2 carriership (OR 4.2; 1.4-12.5) predicted MB incidence. Incident MB patients had more progression of WMH (p < 0.01) and incident lacunar infarcts (p < 0.05). These relations were most prominent for incident nonlobar MBs. Incident strictly lobar MBs were associated with smoking.
Conclusion:
In addition to APOE genotype, presence and progression of small-vessel disease and vascular risk factors were predictors of new MBs. The latter are potentially modifiable, suggesting the possibility of preventing incident MBs, hopefully resulting in slower clinical decline.
Insights
New cerebral microbleeds (MBs) occur in 12% of memory clinic patients. Risk factors like small-vessel disease and APOE genotype predict MBs, suggesting potential for prevention.
Area of Science:
- Neurology
- Radiology
- Geriatrics
Background:
- Cerebral microbleeds (MBs) are common in memory clinic patients.
- Risk factors and incidence of new MBs in this population are poorly understood.
Purpose of the Study:
- Investigate the incidence of lobar and nonlobar MBs.
- Assess risk factors for new MBs and their association with other MRI changes.
Main Methods:
- 254 memory clinic patients underwent serial MRI (1.9 ± 0.9 years).
- MBs, white matter hyperintensities (WMH), WMH progression, and atrophy were assessed.
- APOE genotype was determined in a subset.
Main Results:
- 12% of patients developed new MBs (range 1-19).
- Baseline MBs, WMH grade, lacunar infarcts, and APOE ε2 predicted MB incidence.
- Incident MBs correlated with WMH progression and incident lacunar infarcts.
Conclusions:
- APOE genotype, small-vessel disease, and vascular risk factors predict new MBs.
- Potentially modifiable vascular risk factors suggest MBs may be preventable.
- Preventing MBs could potentially slow clinical decline in memory clinic patients.
