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Microstructural white matter damage on MRI is associated with disease severity in Dutch-type cerebral amyloid

Ingeborg Rasing1, Naomi Vlegels2, Manon R Schipper3

  • 1Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.

Journal of Cerebral Blood Flow and Metabolism : Official Journal of the International Society of Cerebral Blood Flow and Metabolism
|June 17, 2024
PubMed

Insights

Peak width of skeletonized mean diffusivity (PSMD) increases with disease severity in Dutch-type hereditary cerebral amyloid angiopathy (D-CAA). This diffusion-MRI marker correlates with MRI-detected CAA burden and cognitive decline, suggesting its utility in monitoring D-CAA progression.

Area of Science:

  • Neuroimaging
  • Neurology
  • Biomarkers

Background:

  • Cerebral amyloid angiopathy (CAA) involves amyloid-beta deposition in cerebral vasculature, leading to microstructural white matter damage.
  • Early detection of white matter alterations is crucial for understanding CAA progression and developing interventions.
  • Peak width of skeletonized mean diffusivity (PSMD) is an emerging diffusion-MRI marker for assessing white matter microstructure.

Purpose of the Study:

  • To evaluate PSMD across the clinical spectrum of Dutch-type hereditary CAA (D-CAA).
  • To investigate the association of PSMD with other CAA-related MRI markers and cognitive symptoms.
  • To determine PSMD's potential as a tool for monitoring D-CAA progression.

Main Methods:

  • Diffusion-MRI data were acquired from 59 D-CAA mutation carriers (presymptomatic and symptomatic).
  • PSMD was calculated and analyzed in relation to disease severity, cognitive performance (Trail Making Test A), and MRI markers (white matter hyperintensities, microbleeds, SVD burden).
  • Linear regression models were used to assess associations.

Main Results:

  • PSMD levels were significantly higher in symptomatic D-CAA mutation carriers compared to presymptomatic carriers (p < 0.001).
  • PSMD positively correlated with age, CAA-SVD burden (adj.B=0.42, p=0.002), cerebral microbleeds (adj.B=0.30, p=0.009), and white matter hyperintensities (deep: adj.B=0.46, p<0.001; periventricular: adj.B=0.38, p=0.004).
  • Increased PSMD was associated with poorer performance on the TMT-A (B=-0.42, p=0.04), indicating impaired information processing speed.

Conclusions:

  • Microstructural white matter damage in D-CAA is linked to disease phase, CAA burden on MRI, and cognitive impairment.
  • PSMD serves as a global measure of white matter microstructural alterations.
  • PSMD may be a valuable tool for monitoring disease progression in CAA.
Keywords:
Cerebral amyloid angiopathyDutch-type hereditary cerebral amyloid angiopathyMRI CAA-small vessel disease burdencognitive impairmentdiffusion magnetic resonance imaging

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