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Updated: Jul 20, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Cerebral amyloid deposition predicts long-term cognitive decline in hemorrhagic small vessel disease
Ya-Chin Tsai1, Hsin-Hsi Tsai2,3, Chia-Ju Liu4
1Department of Nuclear Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
Background:
To investigate the association between cerebral amyloid deposition and long-term cognitive outcomes in patients with hemorrhagic small vessel disease (SVD) and survivors of intracerebral hemorrhage (ICH).
Methods:
Patients experiencing an ICH without overt dementia were prospectively recruited (n = 68) for brain MRI and Pittsburgh compound B (PiB) positron emission tomography scans at baseline. Cognitive function was assessed using the mini-mental status examination (MMSE) and clinical dementia rating after an overall median follow-up of 3.8 years. A positive amyloid scan was defined as a global PiB standardized uptake value ratio >1.2. Associations between follow-up cognitive outcomes and neuroimaging markers were explored using multivariable Cox regression models.
Results:
PiB(+) patients were older (72.1 ± 7.8 vs. 59.9 ± 11.7, p = .002) and more frequently had cerebral amyloid angiopathy (CAA) (63.6% vs. 15.8%, p = .002) than PiB(-) patients. PiB(+) was associated with a higher risk of dementia conversion (32.9 vs. 4.0 per 100-person-years, hazard ratio [HR] = 15.7 [3.0-80.7], p = .001) and MMSE score decline (58.8 vs. 9.9 per 100-person-years, HR = 6.2 [1.9-20.0], p = .002). In the non-CAA subgroup (n = 52), PiB(+) remained an independent predictor of dementia conversion, p = .04). In the Cox models, PiB(+) was an independent predictor of dementia conversion (HR = 15.8 [2.6-95.4], p = .003) and MMSE score decline (HR = 5.7 [1.6-20.3], p = .008) after adjusting for confounders.
Conclusions:
Cerebral amyloid deposition potentially contributes to long-term cognitive decline in SVD-related ICH.
Insights
Cerebral amyloid deposition is linked to long-term cognitive decline in patients with small vessel disease (SVD) and intracerebral hemorrhage (ICH) survivors. Amyloid-positive individuals face a significantly higher risk of dementia and cognitive decline.
Area of Science:
- Neurology
- Neuroimaging
- Geriatrics
Background:
- Hemorrhagic small vessel disease (SVD) and intracerebral hemorrhage (ICH) survivors face long-term cognitive challenges.
- Cerebral amyloid deposition is a key pathological feature in neurodegenerative diseases.
- The relationship between amyloid burden and cognitive trajectory post-ICH is not fully understood.
Purpose of the Study:
- To investigate the association between cerebral amyloid deposition and long-term cognitive outcomes.
- To determine if amyloid positivity predicts cognitive decline in ICH survivors with SVD.
- To explore the role of amyloid in the progression of cognitive impairment after ICH.
Main Methods:
- Prospective recruitment of 68 ICH patients without dementia.
- Baseline brain MRI and Pittsburgh Compound B (PiB) positron emission tomography (PET) scans.
- Cognitive assessment (MMSE, CDR) and multivariable Cox regression analysis over a median 3.8-year follow-up.
Main Results:
- Amyloid-positive (PiB(+)) patients were older and more likely to have cerebral amyloid angiopathy (CAA).
- PiB(+) was significantly associated with a higher risk of dementia conversion (HR=15.7) and MMSE decline (HR=6.2).
- Amyloid positivity remained an independent predictor of dementia and cognitive decline even after adjusting for confounders.
Conclusions:
- Cerebral amyloid deposition is a significant contributor to long-term cognitive decline in SVD-related ICH.
- Amyloid imaging may identify individuals at higher risk for progressive cognitive impairment post-ICH.
- Further research is warranted to explore therapeutic strategies targeting amyloid in this population.
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