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Incidence of cerebral microbleeds in the general population: the Rotterdam Scan Study
Mariëlle M F Poels1, M Arfan Ikram, Aad van der Lugt
1Department of Radiology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Background And Purpose:
Cerebral microbleeds are frequently seen in the general elderly population, but it is unknown at what rate they occur with aging and whether once present can disappear over time.
Methods:
As part of the Rotterdam Scan Study, 831 persons (mean age, 68.5 years) underwent repeated brain MRI with a mean interval of 3.4 years. We assessed determinants of incident microbleeds in relation to their location with multiple logistic regressions.
Results:
Overall prevalence of microbleeds increased from 24.4% at baseline to 28.0% at follow-up. Eighty-five persons (10.2%) developed new microbleeds. Microbleeds at baseline predicted development of new microbleeds (OR, 5.38; 95% CI, 3.34 to 8.67). In only 6 persons with microbleeds at baseline, fewer microbleeds were present at the follow-up examination. Cardiovascular risk factors, presence of lacunar infarcts, and larger white matter lesion volume at baseline were all associated with incident deep or infratentorial microbleeds, whereas people with the apolipoprotein E ε4/ε4 genotype or larger white matter lesion volume had a higher risk of incident strictly lobar microbleeds.
Conclusions:
Incidence of microbleeds in the general population over a 3-year interval was substantial and microbleeds rarely disappeared. Risk factors for incident microbleeds were similar to those for prevalent microbleeds and differed according to microbleed location. These results support the assessment of microbleeds on T2-weighted MRI as a possible marker of both cerebral amyloid angiopathy and hypertensive vasculopathy progression.
Insights
Cerebral microbleeds are common in older adults and rarely disappear over time. Their incidence is substantial, and risk factors vary by location, suggesting they may indicate disease progression.
Area of Science:
- Neuroimaging
- Geriatrics
- Neurology
Background:
- Cerebral microbleeds are prevalent in the elderly population.
- The rate of microbleed occurrence with aging and their potential resolution over time remain unclear.
Purpose of the Study:
- To determine the incidence rate of cerebral microbleeds in an aging general population.
- To investigate whether previously identified microbleeds can resolve.
- To identify determinants of incident microbleeds based on their location.
Main Methods:
- The Rotterdam Scan Study included 831 participants (mean age 68.5 years).
- Repeated brain MRI scans were performed with a mean follow-up interval of 3.4 years.
- Multiple logistic regression analyses assessed determinants of incident microbleeds, considering their location.
Main Results:
- Microbleed prevalence increased from 24.4% to 28.0% over the follow-up period.
- Eighty-five participants (10.2%) developed new microbleeds; baseline microbleeds predicted new occurrences (OR, 5.38).
- Microbleed resolution was rare (observed in only 6 individuals).
- Cardiovascular risk factors, lacunar infarcts, and white matter lesion volume were associated with deep/infratentorial microbleeds.
- Apolipoprotein E ε4/ε4 genotype and white matter lesion volume were linked to strictly lobar microbleeds.
Conclusions:
- A substantial incidence of cerebral microbleeds occurs over a 3-year interval in the general population, with rare resolution.
- Risk factors for incident microbleeds mirror those for prevalent ones and differ based on microbleed location.
- T2-weighted MRI assessment of microbleeds may serve as a marker for cerebral amyloid angiopathy and hypertensive vasculopathy progression.
