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Updated: Aug 8, 2026
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Cerebral Microbleeds and Superficial Siderosis: Vascular Correlates and Cognition in a Memory Clinic
Hessah Ateeq Alotibi1,2, Juan-Camilo Vargas-Gonzalez1, Paula Alcaide-Leon3
1Neurology, University Health Network, Canada.
Objective:
Cerebral microbleeds (CMBs) and cortical superficial siderosis (cSS) are increasingly recognized in patients with cognitive impairment and are considered markers of cerebral small vessel disease and cerebral amyloid angiopathy (CAA). However, their associated variable and cognitive impact remain under-characterized in memory clinic populations.
Methods:
We retrospectively reviewed 2923 patients referred for cognitive complaints who underwent brain MRI at the University Health Network (Toronto, 2014-2022). Of these, 137 patients with CMBs and/or cSS were compared with 278 control patients without hemorrhagic findings, sampled at an approximately 2:1 ratio from the CMB/cSS-negative pool. We analyzed vascular-associated variable, Fazekas-rated white matter hyperintensities (WMH), lesion location and cognitive performance (Mini-Mental State Examination or Montreal Cognitive Assessment). Probable CAA was classified using Boston Criteria v2.0.
Results:
CMBs and/or cSS were present in 4.7% of the cohort. Of the 137 cases, 103 had CMBs only, 9 had cSS only and 25 had both. Thirty-one patients (22.6%) met criteria for probable CAA. The CMB/cSS group was older, had higher rates of hypertension and had greater WMH burden. Cognitive scores were lower in the CMB/cSS group, but in multivariable models, only lower education remained a significant predictor. WMH severity showed a stronger association with cognitive performance than the presence or topography of CMBs or cSS.
Conclusion:
CMBs and cSS co-occur with vascular-associated variables and WMH burden, while their independent association with cognition is modest in cross-sectional analyses. The proportion meeting probable CAA supports diagnostic relevance. Considering hemorrhagic markers alongside WMH may better characterize vascular contributions to dementia in routine clinical assessment.
Insights
Cerebral microbleeds and cortical superficial siderosis are common in memory clinic patients and linked to vascular issues. White matter hyperintensities, not these markers alone, significantly impact cognition.
Area of Science:
- Neurology
- Neuroimaging
- Cognitive Science
Background:
- Cerebral microbleeds (CMBs) and cortical superficial siderosis (cSS) are recognized markers of small vessel disease and cerebral amyloid angiopathy (CAA).
- Their prevalence and cognitive impact in memory clinic populations are not well-defined.
Purpose of the Study:
- To investigate the association of CMBs and cSS with vascular risk factors and cognitive performance in patients with cognitive complaints.
- To determine the diagnostic relevance of these markers for probable CAA.
Main Methods:
- Retrospective analysis of 2923 patients with cognitive complaints undergoing brain MRI.
- Comparison of 137 patients with CMBs/cSS against 278 controls.
- Assessment of white matter hyperintensities (WMH), lesion location, and cognitive scores (MMSE/MoCA).
- Classification of probable CAA using Boston Criteria v2.0.
Main Results:
- CMBs/cSS detected in 4.7% of the cohort; 22.6% met criteria for probable CAA.
- The CMB/cSS group exhibited higher age, hypertension rates, and WMH burden.
- Cognitive scores were lower in the CMB/cSS group, but WMH severity was a stronger predictor than CMBs/cSS presence or location.
Conclusions:
- CMBs and cSS are associated with vascular factors and WMH, but show a modest independent link to cognition in cross-sectional analysis.
- The findings support the diagnostic relevance of CMBs and cSS for CAA.
- Integrating hemorrhagic markers with WMH assessment may improve characterization of vascular contributions to dementia.
