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Associations Between Cerebral Microbleed Patterns and Incident Dementia: The ARIC-Neurocognitive Study

Richard Q Vuong1, Valerie N Morrill1, Jonathan Graff-Radford2

  • 1Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, National Institutes of Health, Bethesda, MD (R.Q.V., V.N.M., R.F.G.).

Stroke
|February 27, 2026
PubMed
Abstract

Insights

Cerebral microbleeds (CMBs) in lobar or mixed patterns, and higher CMB counts, increase dementia risk. Subcortical CMBs alone did not show this association, indicating pattern-specific risks.

Area of Science:

  • Neuroimaging
  • Neurology
  • Epidemiology

Background:

  • Cerebral microbleeds (CMBs) are linked to dementia, but the impact of specific patterns, like lobar (often from cerebral amyloid angiopathy) versus subcortical (often hypertensive), requires clarification.
  • Cortical superficial siderosis (cSS) can co-occur with lobar CMBs, potentially influencing dementia risk.
  • Understanding distinct CMB patterns is crucial for assessing dementia risk accurately.

Purpose of the Study:

  • To investigate the association between the presence, patterns, and frequency of cerebral microbleeds (CMBs) and the risk of developing dementia.
  • To differentiate the dementia risk associated with various CMB patterns, including lobar, subcortical, mixed, and those with cSS.
  • To determine if the number of CMBs correlates with dementia risk across different subtypes.

Main Methods:

  • Analysis of a community-based longitudinal cohort (ARIC-NCS) using 3T MRI at visit 5.
  • Classification of CMB patterns: no CMBs, subcortical only, mixed (subcortical and lobar±cSS), lobar±cSS only, or cSS.
  • Dementia adjudication via blinded review; Cox proportional hazards models used to assess dementia risk associations, adjusted for covariates.

Main Results:

  • Among 1583 participants, 361 had CMBs. Mixed (HR, 1.99) and lobar±cSS (HR, 1.96) CMB patterns were associated with increased dementia risk compared to no CMBs.
  • Subcortical-only CMB patterns did not show a significant association with increased dementia risk (HR, 1.04).
  • Presence of cSS (HR, 2.57) and increasing numbers of CMBs across all subtypes were associated with higher dementia risk.

Conclusions:

  • Lobar and mixed cerebral microbleed (CMB) patterns, along with a higher CMB burden, are significantly associated with incident dementia.
  • The study highlights differential associations of specific CMB patterns with dementia risk.
  • A substantial disease burden, irrespective of CMB distribution, is linked to an elevated risk of dementia.
Keywords:
cerebral amyloid angiopathycerebral small vessel diseasesdementiahypertensionmagnetic resonance imagingprospective studies

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