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Cerebral microbleed incidence, relationship to amyloid burden: The Mayo Clinic Study of Aging

Jonathan Graff-Radford1, Timothy Lesnick2, Alejandro A Rabinstein2

  • 1From the Departments of Neurology (J.G.-R., A.A.R., R.D.B., M.M.M., D.S.K., R.C.P.), Health Sciences Research (T.L., J.G., J.A., S.A.P., M.M.M., W.K.), and Radiology (A.J.S., J.H., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN. Graff-Radford.Jonathan@mayo.edu.

Neurology
|December 6, 2019
PubMed
Abstract

Insights

Cerebral microbleeds (CMBs) increase with age. While amyloid PET burden and APOE4 status contribute to new CMBs, existing CMBs are the strongest predictor of future occurrences.

Area of Science:

  • Neurology
  • Neuroimaging
  • Gerontology

Background:

  • Cerebral microbleeds (CMBs) are small, punctate hemorrhages in the brain.
  • Amyloid PET imaging is used to detect amyloid plaques, a hallmark of Alzheimer's disease.
  • Understanding risk factors for CMBs is crucial for predicting and potentially preventing cerebrovascular events.

Purpose of the Study:

  • To determine the incidence rate of cerebral microbleeds (CMBs).
  • To investigate the association between amyloid PET burden and the development of incident CMBs.
  • To identify key predictors of future CMBs, including age, APOE4 status, and baseline CMBs.

Main Methods:

  • 651 participants (age ≥50) underwent serial 3T MRI and 87% had 11C Pittsburgh compound B (PiB) PET scans.
  • Age-specific CMB incidence rates were calculated using piecewise exponential models.
  • Structural equation models (SEMs) assessed the influence of amyloid load and baseline CMBs on future CMBs, controlling for covariates.

Main Results:

  • The overall CMB incidence rate was 3.6/100 person-years, increasing significantly with age.
  • Higher amyloid load, particularly in the occipital lobe, was associated with an increased risk of new lobar CMBs.
  • The presence of baseline CMBs was a stronger predictor of future lobar CMBs than amyloid load.

Conclusions:

  • Age and APOE4 carrier status increase lobar CMB risk indirectly through amyloid load.
  • Existing cerebral microbleeds are the most significant risk factor for developing future CMBs.
  • These findings highlight the complex interplay of aging, amyloid pathology, and pre-existing microbleeds in CMB development.

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