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Clinical impact of microbleeds in patients with Alzheimer's disease
Daniel Vázquez-Justes1, Iván Aguirregoicoa2, Leandre Fernandez3
1Neurology Department, Clinical Neuroscience Research Group, IRBLleida-Hospital Universitari Arnau de Vilanova, Lleida, Spain.
Introduction:
Cerebral microbleeds (CMBs) are more frequent in patients with Alzheimer's disease (AD) than in the general population. However, their clinical significance remains poorly understood. We carried out a multimodal approach to evaluate the impact of CMBs at a clinical, neuropsychological, and survival level, as well as on core AD biomarkers in the cerebrospinal fluid (CSF) in AD patients.
Methods:
We prospectively recruited 98 patients with mild-moderate AD. At baseline, they underwent brain MRI, and AD CSF biomarkers and APOE genotypes were analysed. An extensive neuropsychological battery was performed at baseline and after 1 year of follow-up. We analysed the stroke incidence and mortality with survival analyses.
Results:
Forty-eight (48.5%) patients had at least one CMBs. Eight (8.2%) patients had strictly nonlobar CMBs, 39 (40.2%) had any lobar CMB locations. The incidence of stroke was higher in AD patients with lobar CMBs than in those without CMBs (p < 0.05). Mortality did not differ among groups (p > 0.05). At the cognitive level, CMBs patients deteriorated more rapidly at 12 months according to MMSE scores, with no differences observed at 24 months. We did not observe differences in the other tests, except for an increase in caregiver burden in the CMBs group. The presence of cerebral amyloidosis and APOE ε4 were associated with a greater presence of CMBs.
Conclusion:
CMBs are associated with an increased risk of ischemic stroke in AD patients without differences in mortality. Patients with CMBs did not seem to have different consequences associated with cognitive decline except for an increase in caregiver overload.
Insights
Cerebral microbleeds (CMBs) increase stroke risk in Alzheimer's disease (AD) patients but do not affect mortality. While cognitive decline was not significantly different long-term, CMBs were linked to increased caregiver burden.
Area of Science:
- Neurology
- Neuroimaging
- Geriatrics
Background:
- Cerebral microbleeds (CMBs) are common in Alzheimer's disease (AD) but their clinical impact is unclear.
- Understanding CMBs' role is crucial for managing AD progression and patient outcomes.
Purpose of the Study:
- To investigate the clinical significance of CMBs in AD patients.
- To evaluate the impact of CMBs on clinical, neuropsychological, and survival outcomes, and AD biomarkers.
Main Methods:
- Prospective study of 98 mild-moderate AD patients.
- Baseline assessments included brain MRI, CSF AD biomarkers, APOE genotyping, and neuropsychological testing.
- Follow-up included 1-year neuropsychological testing, stroke incidence, and mortality analysis.
Main Results:
- 48.5% of AD patients had CMBs; lobar CMBs were associated with higher stroke incidence (p<0.05).
- No significant differences in mortality were observed.
- CMB patients showed faster cognitive decline on MMSE scores at 12 months, and increased caregiver burden.
Conclusions:
- CMBs are associated with increased ischemic stroke risk in AD patients, but not mortality.
- Cognitive decline differences were transient, but caregiver burden increased in patients with CMBs.
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