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Microbleeds in dementia with Lewy bodies
Paul C Donaghy1, Michael Firbank2, Dipayan Mitra3
1Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK. paul.donaghy@ncl.ac.uk.
Introduction:
Microbleeds are associated with the development of dementia in older people and are common in Alzheimer's disease (AD). Their prevalence and clinical importance in dementia with Lewy bodies (DLB) is unclear. The objective of this study was to compare the rates of microbleeds in DLB with those in AD and healthy older people, and investigate associations between microbleeds and amyloid deposition, vascular risk and disease severity in DLB.
Methods:
DLB (n = 30), AD (n = 18) and control (n = 20) participants underwent clinical assessment at baseline and 1 year in this longitudinal observational study. 3T MRI (including T2* susceptibility weighted imaging) and florbetapir PET were carried out at baseline. Microbleeds were rated visually and a standardised uptake value ratio (SUVR) was calculated from florbetapir PET scans.
Results:
40% of DLB subjects had microbleeds compared with 50% of AD and 15% of controls. Compared to DLB without microbleeds, those with microbleeds had higher systolic BP (156 ± 26 v. 135 ± 19 mmHg; p = 0.03), but did not have greater levels of vascular disease or amyloid deposition (SUVR 1.25 ± 0.24 v. 1.25 ± 0.22; p = 0.33). There was evidence of less severe dementia in DLB participants with microbleeds, but these differences may have been driven by a shorter disease duration in those with microbleeds.
Conclusion:
The presence of microbleeds in DLB is associated with higher blood pressure, but not with other measures of vascular disease or amyloid deposition. The relationship between microbleeds and clinical presentation remains unclear.
Insights
Microbleeds are common in dementia with Lewy bodies (DLB) and Alzheimer's disease (AD), associated with higher blood pressure in DLB. Their link to disease severity and amyloid deposition requires further investigation.
Area of Science:
- Neurology
- Neuroimaging
- Geriatrics
Background:
- Cerebral microbleeds are linked to dementia and prevalent in Alzheimer's disease (AD).
- The prevalence and clinical significance of microbleeds in dementia with Lewy bodies (DLB) are not well understood.
- This study investigates microbleeds in DLB compared to AD and healthy controls.
Purpose of the Study:
- To compare microbleed rates in DLB, AD, and controls.
- To examine associations between microbleeds and amyloid deposition in DLB.
- To explore the relationship between microbleeds, vascular risk, and disease severity in DLB.
Main Methods:
- A longitudinal observational study involving DLB (n=30), AD (n=18), and control (n=20) participants.
- Clinical assessments, 3T MRI with T2* susceptibility weighted imaging, and florbetapir PET scans were performed.
- Microbleeds were visually rated, and amyloid deposition was quantified using standardized uptake value ratio (SUVR).
Main Results:
- Microbleeds were present in 40% of DLB, 50% of AD, and 15% of controls.
- DLB participants with microbleeds had higher systolic blood pressure (p=0.03) but not increased vascular disease or amyloid deposition (p=0.33).
- Preliminary evidence suggested less severe dementia in DLB with microbleeds, potentially due to shorter disease duration.
Conclusions:
- Microbleeds in DLB are associated with elevated blood pressure.
- Microbleeds in DLB are not linked to other vascular disease markers or amyloid burden.
- The clinical implications of microbleeds in DLB remain uncertain and warrant further research.
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