Neuropsychological and Neuroimaging Markers in Cerebral Amyloid Angiopathy: A Cross-Sectional Population-Based Study
Year: 2024
Type: dissertation
Study design: Observational Study
Abstract: Background: Sporadic, age-related cerebral amyloid angiopathy (CAA) is most commonly recognized clinically as a cause of intracerebral hemorrhage (ICH). Based on the modified Boston criteria, CAA was traditionally linked with hemorrhagic and non-hemorrhagic markers. However, in the last 10 years, research has linked CAA with brain atrophy in regions remote from those directly affected by ICH, and with the risk for progressive cognitive decline in the absence of new hemorrhagic strokes. However, few studies have examined deficits across cognitive domains in the chronic phase and their relationship with brain MRI markers. Methods: Neuropsychological assessment and brain MRI were performed on 25 ICH-CAA patients 15 months after the index event. Sixteen neuropsychological tests were used to form composite measures of 11 separate cognitive domains and global cognition. MRI presence of enlarged perivascular spaces (EPVS), white matter hyperintensities (WMH), microbleeds, and cortical superficial siderosis (cSS) were summed in a composed score of CAA total score representing all CAA features combined. Neurodegeneration was measured by the medial temporal atrophy (MTA) and the global cortical atrophy (GCA) scales. Results: Regarding cognition, patients without previous dementia performed adequately on a wide range of cognitive tests compared with subjects of similar age and educational level. However, the processes in which they had the lowest performance were processing speed with a t score of 42 ± 1.47 (mean ± standard deviation), followed by memory (44 ± 1.61) and planning (44 ± 1.97). Furthermore, none of the patients in our cohort had affective symptoms and were functionally independent. Correlational analysis revealed a significant association between MTA and most of the processes assessed (Attention: p=0.002, adjusted R2= 31; Planning: p= 0.006, adjusted R2= 26; Verbal fluency: p=0.001, adjusted R2= 35); Language: p=0.001, adjusted R2= 36; Memory: p=0.003, adjusted R2= 29; Visuospatial: p=0.005, adjusted R2= 26; Visuoconstruction: p=0.006, adjusted R2= 26). Besides, a significant correlation was found between CAA total score and GCA with Memory (p=0.018, adjusted R2= 19; p=0.021, adjusted R2= 15) and Visuoperception (p=0.0326, adjusted R2= 15; p=0.022, adjusted R2= 17). Conclusions: Lobar ICH-CAA survivors have adequate cognitive and functional performance 15 months after the index event. Moreover, they do not present affective symptoms. MTA is the brain structural marker that may influence and contribute to the final clinical picture of this neurodegenerative process affecting almost most of the cognitive domains assessed, not only episodic memory as previously thought. GCA and hemorrhagic and ischemic brain markers have a significant correlation with memory and visuoperception function. In our cohort, CAA-related neuroimaging markers, rather than ICH volume and location, could be predictors of long-term dementia incidence.
Author: Giménez-Paños, C.
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7002340242