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Cerebrovascular Risk Factors in Possible or Probable Cerebral Amyloid Angiopathy, Modifier or Bystander?
Andrea Wagner1, Jonas Maderer1, Sibylle Wilfling1
1Department of Neurology, University of Regensburg, Regensburg, Germany.
Insights
Cerebral amyloid angiopathy (CAA) patients often have multiple stroke risk factors. These comorbidities, like hypertension and diabetes, vary by initial presentation, influencing disease course and offering secondary prevention targets.
Area of Science:
- Neurology
- Vascular Neurology
- Geriatric Neurology
Background:
- Cerebral amyloid angiopathy (CAA) is a common cause of intracerebral hemorrhage in older adults.
- Stroke risk factors including arterial hypertension (AHT), atrial fibrillation (AFib), diabetes mellitus (DM), and renal dysfunction (RD) are prevalent in CAA patients.
Purpose of the Study:
- To analyze stroke risk factors in patients with different initial CAA presentations.
- To evaluate the influence of these risk factors on the initial clinical presentation of CAA.
Main Methods:
- Retrospective study of 209 patients with possible CAA (modified Boston criteria) from 2002-2018.
- Analysis of stroke risk factors (AHT, AFib, DM, RD) in relation to initial CAA manifestations (CMB, AIS, cSS, LICH).
Main Results:
- High multimorbidity observed in the CAA cohort.
- Patients with cerebral microbleeds (CMB) as initial presentation had the most cerebrovascular risk factors and recurrent acute ischemic stroke (AIS).
- Atrial fibrillation (AFib) was more frequent in the neurosurgery cohort.
Conclusions:
- A distinct overlap exists between CAA manifestations and stroke risk factors.
- These comorbidities likely influence CAA's clinical course and are potential targets for secondary prevention.
- Further verification in larger cohorts is needed.
Abstract:
Goal: Cerebral amyloid angiopathy (CAA) is a frequent cause of atypical intracerebral hemorrhage (ICH) in the elderly. Stroke risk factors such as arterial hypertension (AHT), atrial fibrillation (AFib), diabetes mellitus (DM), and renal dysfunction (RD) are increasingly apparent in these patients. In this retrospective study, we analyzed the presence of these stroke risk factors in different initial CAA presentations comprising cerebral microbleeds (CMB), acute ischemic stroke (AIS), cortical superficial hemosiderosis (cSS), or lobar ICH (LICH) and evaluated their influence on the initial clinical presentation of patients with CAA. Material and Methods: We identified patients with at least possible CAA defined by the modified Boston criteria admitted to the Department of Neurology or Neurosurgery from 2002 to 2018. Findings: In the overall cohort of 209 patients, we analyzed the correlation between the number of stroke risk factors and the initial clinical presentation of patients with CAA and could show the high multimorbidity of the collective. There are large differences between the subgroups with different initial clinical presentations, e.g., patients with CMB as initial CAA presentation have the highest number of cerebrovascular risk factors and recurrent AIS, whereas AFib is more frequent in the Neurosurgery Department. Conclusion: There is a distinct overlap between the subgroups of CAA manifestations and stroke risk factors that need to be verified in larger patient collectives. Since these comorbidities are likely to influence the clinical course of CAA, they represent possible targets for secondary prevention until specific treatment for CAA becomes available.
