Distinctive Clinical Effects of Haemorrhagic Markers in Cerebral Amyloid Angiopathy
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Published on: November 15, 2024
Young Kyoung Jang1,2, Hee Jin Kim1,2, Jin San Lee3
1Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, 06351, Korea.
Insights
Restricted lobar cerebral microbleeds (CMBs) and cortical superficial siderosis (CSS) in cerebral amyloid angiopathy (CAA) are linked to distinct patterns of brain thinning and cognitive deficits, offering new insights into disease mechanisms.
Area of Science:
- Neurology
- Neuroimaging
- Gerontology
Background:
- Cerebral amyloid angiopathy (CAA) is characterized by amyloid-beta deposition in cerebral vasculature.
- Restricted lobar cerebral microbleeds (CMBs) and cortical superficial siderosis (CSS) are key imaging markers of CAA.
- The clinical implications of CMBs and CSS in CAA remain incompletely understood.
Purpose of the Study:
- To investigate the clinical significance of CMBs and CSS in patients with clinically and radiologically diagnosed CAA.
- To determine the association between these markers and cognitive function.
- To explore the relationship between these markers, cortical thinning, and cognitive impairment.
Main Methods:
- A cohort of 372 patients with possible or probable CAA was recruited.
- Cortical thickness was assessed using surface-based neuroimaging methods.
- Statistical analyses were performed to evaluate associations between CMBs, CSS, cortical thinning, and cognitive performance.
Main Results:
- Restricted multiple lobar CMBs correlated with widespread cortical thinning.
- CSS was associated with cortical thinning predominantly in the frontal regions.
- CMBs impacted all cognitive domains, while CSS affected attention and frontal executive functions, with partial mediation by cortical thinning.
Conclusions:
- Restricted lobar CMBs and CSS are associated with distinct patterns of cortical thinning and cognitive dysfunction in CAA.
- These findings provide novel insights into the pathophysiological mechanisms underlying CAA.
- Targeting these specific pathological features may offer potential therapeutic avenues for CAA patients.
Abstract:
Restricted lobar cerebral microbleeds (CMBs) and cortical superficial siderosis (CSS) are the characteristic markers of cerebral amyloid angiopathy (CAA). However, their effects on clinical features has not been evaluated well. The purpose of this study is to investigate the clinical implication of these markers in clinical-radiologically diagnosed CAA. A total of 372 patients with possible or probable CAA who met the modified Boston criteria were recruited in a memory clinic setting. Cortical thickness was measured using surface based methods. Presence of restricted multiple lobar CMBs were independently associated with cortical thinning across the entire cortical regions while presence of CSS was independently associated with cortical thinning primarily in the bilateral frontal region. Presence of restricted multiple lobar CMBs was associated with impairment in all cognitive domains such as attention, language, visuospatial, memory and frontal executive functions while presence of CSS was associated with attention and frontal dysfunction. The relationships of restricted multiple lobar CMBs or CSS with cognitive impairment were partially mediated by thinning in the corresponding cortical regions. Our findings suggested that restricted multiple lobar CMBs and CSS affect distinctive clinical features, providing new insights into potential mechanisms in CAA.
