Title:Cognitive Versus Hemorrhagic Onset in Cerebral Amyloid Angiopathy:
Neuroimaging Features
Volume: 20
Issue: 4
Author(s): Giulia Perini*, Matteo Cotta Ramusino, Lisa Maria Farina, Beatrice Dal Fabbro, Isabella Canavero, Marta Picascia, Shaun Muzic, Elena Ballante, Anna Cavallini, Anna Pichiecchio and Alfredo Costa
Affiliation:
- Unit of Behavioral Neurology and Center for Cognitive Disorders and Dementias (CDCD), IRCCS Mondino Foundation,
Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
Keywords:
Cerebral amyloid angiopathy, clinical presentation, neuroimaging markers, cognitive decline, intracerebral macrohemorrhage, Alzheimer’s disease.
Abstract:
Background: Intracerebral hemorrhage and cognitive decline are typical clinical presentations
of cerebral amyloid angiopathy (CAA).
Objective: To determine whether magnetic resonance imaging (MRI) features differ between CAA
with hemorrhagic versus cognitive onset.
Methods: In this retrospective study, sixty-one patients with CAA were classified by onset presentation
of the disease: hemorrhage (n = 31) or cognitive decline (n = 30). The two groups were compared
for MRI markers of small vessel disease, namely cerebral microbleeds (CMBs), cortical superficial
siderosis, white matter hyperintensities (WMHs), enlarged perivascular spaces, cortical microinfarcts,
and visual rating scales for cortical atrophy. In the patients with cognitive onset, further exploratory
analyses investigated MRI markers according to cerebrospinal fluid (CSF) and neuropsychological
profiles.
Results: Patients with cognitive onset showed a higher prevalence of CMBs (p < 0.001), particularly
in temporal (p = 0.015) and insular (p = 0.002) lobes, and a higher prevalence of WMHs (p = 0.012).
Within the cognitive onset group, 12 out of 16 (75%) patients had an Alzheimer’s disease (AD) CSF
profile but did not differ in MRI markers from those without AD pathology. Patients with cognitive
onset displayed a multidomain profile in 16 out of 23 (70%) cases; patients with this profile showed
increased WMHs and CMBs in parietal lobes compared with the amnestic group (p = 0.002) and
dysexecutive group (p = 0.032), respectively.
Conclusion: Higher burdens of WMHs and CMBs, especially in temporal and insular lobes, are associated
with the cognitive onset of CAA. MRI markers could help to shed light on the clinical heterogeneity
of the CAA spectrum and its underlying mechanisms.
