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Cerebral microbleeds and risk of incident dementia: the Framingham Heart Study
José R Romero1, Alexa Beiser2, Jayandra J Himali3
1Department of Neurology, School of Public Health at Boston University, Boston, MA, USA; NHLBI's Framingham Heart Study, Framingham, MA, USA.
Abstract:
Cerebral microbleeds (CMBs) are MRI markers attributed to the most common cerebral angiopathies in the elderly and in patients with dementia: hypertensive and cerebral amyloid angiopathy. CMB detection in asymptomatic persons may help identify those at risk for dementia and may influence preventive strategies and design of clinical trials testing treatments for dementia. We studied the association of CMB with risk of incident dementia in community dwelling individuals. A total of 1296 dementia-free Framingham Heart Study participants (mean age 72 years; 54% women) with available brain MRI and incident dementia data during a mean follow-up period of 6.7 years were included. Using Cox proportional hazards models, we related CMB presence to incident dementia. Multivariable models were adjusted for age, sex, APOE status, and education, with additional models adjusting for vascular risk factors and MRI markers of ischemic brain injury. CMBs were observed in 10.8% and incident dementia in 85 participants (6.6% over study period). Participants with any CMB had 1.74 times higher risk of dementia (hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.00-3.01), whereas those with deep and mixed CMB had a three-fold increased risk (HR 2.99, 95% CI 1.52-5.90). The associations were independent of vascular risk factors, and for deep and mixed CMB also independent of MRI markers of ischemia (HR 2.44, 95% CI 1.22-4.88). Purely lobar CMBs were not associated with incident dementia. Our findings support a role for hypertensive vasculopathy and the interplay of hypertensive and cerebral amyloid angiopathy in risk of dementia and suggest that CMB presence can identify individuals at risk of dementia.
Insights
Cerebral microbleeds (CMBs) detected via MRI indicate increased dementia risk, particularly deep and mixed types. Identifying CMBs may aid in early dementia risk assessment and prevention strategies.
Area of Science:
- Neurology
- Radiology
- Geriatrics
Background:
- Cerebral microbleeds (CMBs) are MRI markers linked to common cerebral angiopathies in the elderly and dementia patients.
- Hypertensive and cerebral amyloid angiopathy are key contributors to CMBs.
- Early detection of CMBs in asymptomatic individuals can identify dementia risk and inform preventive measures.
Purpose of the Study:
- To investigate the association between cerebral microbleeds (CMBs) and the risk of developing incident dementia in community-dwelling individuals.
- To determine if CMB presence influences dementia risk independently of vascular risk factors and ischemic brain injury.
Main Methods:
- A cohort of 1296 dementia-free participants from the Framingham Heart Study with available brain MRI and dementia data were analyzed.
- Cox proportional hazards models were used to assess the relationship between CMB presence and incident dementia over a mean follow-up of 6.7 years.
- Analyses were adjusted for age, sex, APOE status, education, vascular risk factors, and MRI markers of ischemic brain injury.
Main Results:
- Cerebral microbleeds (CMBs) were detected in 10.8% of participants.
- Participants with any CMB showed a 1.74 times higher risk of dementia (HR 1.74, 95% CI 1.00-3.01).
- Deep and mixed CMBs were associated with a three-fold increased dementia risk (HR 2.99, 95% CI 1.52-5.90), independent of other factors.
Conclusions:
- The presence of cerebral microbleeds (CMBs), especially deep and mixed types, is a significant predictor of incident dementia.
- Findings support the role of hypertensive vasculopathy and its interplay with cerebral amyloid angiopathy in dementia risk.
- CMB detection on MRI can identify individuals at higher risk for dementia, aiding in risk stratification and trial design.