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Charidimou A, Boulouis G. Core CSF Biomarker Profile in Cerebral Amyloid Angiopathy: Updated Meta-Analysis. Neurology 2024; 103:e209795. [PMID: 39270153 DOI: 10.1212/wnl.0000000000209795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND AND OBJECTIVES There is a clear need to characterize and validate molecular biomarkers of cerebral amyloid angiopathy (CAA), in an effort to improve diagnostics, especially in the context of patients with Alzheimer disease (AD) receiving immunotherapies (for whom underlying CAA is the driver of amyloid-related imaging abnormalities). We performed an updated meta-analysis of 5 core CSF biomarkers (Aβ42, Aβ40, Aβ438, total tau [T-tau], and phosphorylated tau [P-tau]) to assess which of these are most altered in sporadic CAA. METHODS We systematically searched PubMed for eligible studies reporting data on CSF biomarkers reflecting APP metabolism (Aβ42, Aβ40, Aβ38), neurodegeneration (T-tau), and tangle pathology (P-tau), in symptomatic sporadic CAA cohorts (based on the Boston criteria) vs control groups and/or vs patients with AD. Biomarker performance was assessed in random-effects meta-analysis based on ratio of mean (RoM) biomarker concentrations in (1) patients with CAA to controls and (2) CAA to patients with AD. RoM >1 indicates higher biomarker concentration in CAA vs comparison population, and RoM <1 indicates higher concentration in comparison groups. RESULTS 8 studies met inclusion criteria: a total of 11 CAA cohorts (n = 289), 9 control cohorts (n = 310), and 8 AD cohorts (n = 339). Overall included studies were of medium quality based on our assessment tools. CAA to controls had lower mean level of all amyloid markers with CSF Aβ42, Aβ40, and Aβ38 RoMs of 0.46 (95% CI 0.38-0.55, p < 0.0001), 0.70 (95% CI 0.63-0.78, p < 0.0001), and 0.71 (95% CI 0.56-0.89, p = 0.003), respectively. CSF T-tau and P-tau RoMs of patients with CAA to controls were both greater than 1: 1.56 (95% CI 1.32-1.84, p < 0.0001) and 1.31 (95% CI 1.13-1.51, p < 0.0001), respectively. Differentiation between CAA and AD was strong for CSF Aβ40 (RoM 0.76, 95% CI 0.69-0.83, p < 0.0001) and Aβ38 (RoM 0.55, 95% CI 0.38-0.81, p < 0.0001), but not Aβ42 (RoM 1.00; 95% CI 0.81-1.23, p = 0.970). For T-tau and P-tau, average CSF ratios in patients with CAA vs AD were 0.64 (95% CI 0.58-0.71, p < 0.0001) and 0.64 (95% CI 0.58-0.71, p < 0.0001), respectively. DISCUSSION Specific CSF patterns of Aβ42, Aβ40, Aβ38, T-tau, and P-tau might serve as molecular biomarkers of CAA, in research and clinical settings, offering the potential to improve the clinical diagnostic approach pathway in specific scenarios.
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Affiliation(s)
- Andreas Charidimou
- From the Department of Neurology (A.C.), Boston University Medical Center, Boston University School of Medicine, MA; and Diagnostic and Interventional Neuroradiology (G.B.), University Hospital, Tours, France
| | - Gregoire Boulouis
- From the Department of Neurology (A.C.), Boston University Medical Center, Boston University School of Medicine, MA; and Diagnostic and Interventional Neuroradiology (G.B.), University Hospital, Tours, France
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Switzer AR, Charidimou A, McCarter S, Vemuri P, Nguyen AT, Przybelski SA, Lesnick TG, Rabinstein AA, Brown RD, Knopman DS, Petersen RC, Jack CR, Reichard RR, Graff-Radford J. Boston Criteria v2.0 for Cerebral Amyloid Angiopathy Without Hemorrhage: An MRI-Neuropathologic Validation Study. Neurology 2024; 102:e209386. [PMID: 38710005 PMCID: PMC11177590 DOI: 10.1212/wnl.0000000000209386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/20/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Updated criteria for the clinical-MRI diagnosis of cerebral amyloid angiopathy (CAA) have recently been proposed. However, their performance in individuals without symptomatic intracerebral hemorrhage (ICH) presentations is less defined. We aimed to assess the diagnostic performance of the Boston criteria version 2.0 for CAA diagnosis in a cohort of individuals ranging from cognitively normal to dementia in the community and memory clinic settings. METHODS Fifty-four participants from the Mayo Clinic Study of Aging or Alzheimer's Disease Research Center were included if they had an antemortem MRI with gradient-recall echo sequences and a brain autopsy with CAA evaluation. Performance of the Boston criteria v2.0 was compared with v1.5 using histopathologically verified CAA as the reference standard. RESULTS The median age at MRI was 75 years (interquartile range 65-80) with 28/54 participants having histopathologically verified CAA (i.e., moderate-to-severe CAA in at least 1 lobar region). The sensitivity and specificity of the Boston criteria v2.0 were 28.6% (95% CI 13.2%-48.7%) and 65.3% (95% CI 44.3%-82.8%) for probable CAA diagnosis (area under the receiver operating characteristic curve [AUC] 0.47) and 75.0% (55.1-89.3) and 38.5% (20.2-59.4) for any CAA diagnosis (possible + probable; AUC 0.57), respectively. The v2.0 Boston criteria were not superior in performance compared with the prior v1.5 criteria for either CAA diagnostic category. DISCUSSION The Boston criteria v2.0 have low accuracy in patients who are asymptomatic or only have cognitive symptoms. Additional biomarkers need to be explored to optimize CAA diagnosis in this population.
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Affiliation(s)
- Aaron R Switzer
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Andreas Charidimou
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Stuart McCarter
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Prashanthi Vemuri
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Aivi T Nguyen
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Scott A Przybelski
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Timothy G Lesnick
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Alejandro A Rabinstein
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Robert D Brown
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - David S Knopman
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Ronald C Petersen
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Clifford R Jack
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - R Ross Reichard
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
| | - Jonathan Graff-Radford
- From the Department of Neurology (A.R.S., S.M., A.A.R., R.D.B., D.S.K., R.C.P., J.G.-R.), Mayo Clinic Rochester, MN; Department of Neurology (A.R.S.), University of Calgary, Canada; Department of Neurology (A.C.), Boston University Chobanian & Avedisian School of Medicine; and Department of Radiology (P.V., C.R.J.), Department of Pathology (A.T.N., R.R.R.), Department of Quantitative Health Sciences (S.A.P.), and Health Sciences Research (T.G.L.), Mayo Clinic Rochester, MN
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Rasing I, Voigt S, Koemans EA, de Kort AM, van Harten TW, van Etten ES, van Zwet EW, Stoops E, Francois C, Kuiperij HB, Klijn CJM, Schreuder FHBM, van der Weerd L, van Osch MJP, van Walderveen MAA, Verbeek MM, Terwindt GM, Wermer MJH. Serum and cerebrospinal fluid neurofilament light chain and glial fibrillary acid protein levels in early and advanced stages of cerebral amyloid Angiopathy. Alzheimers Res Ther 2024; 16:86. [PMID: 38654326 PMCID: PMC11036675 DOI: 10.1186/s13195-024-01457-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Neurofilament light chain (NFL) is a biomarker for neuroaxonal damage and glial fibrillary acidic protein (GFAP) for reactive astrocytosis. Both processes occur in cerebral amyloid angiopathy (CAA), but studies investigating the potential of NFL and GFAP as markers for CAA are lacking. We aimed to investigate NFL and GFAP as biomarkers for neuroaxonal damage and astrocytosis in CAA. METHODS For this cross-sectional study serum and cerebrospinal fluid (CSF) samples were collected between 2010 and 2020 from controls, (pre)symptomatic Dutch-type hereditary (D-CAA) mutation-carriers and participants with sporadic CAA (sCAA) from two prospective CAA studies at two University hospitals in the Netherlands. NFL and GFAP levels were measured with Simoa-assays. The association between NFL and GFAP levels and age, cognitive performance (MoCA), CAA-related MRI markers (CAA-CSVD-burden) and Aβ40 and Aβ42 levels in CSF were assessed with linear regression adjusted for confounders. The control group was divided in age < 55 and ≥55 years to match the specific groups. RESULTS We included 187 participants: 28 presymptomatic D-CAA mutation-carriers (mean age 40 years), 29 symptomatic D-CAA participants (mean age 58 years), 59 sCAA participants (mean age 72 years), 33 controls < 55 years (mean age 42 years) and 38 controls ≥ 55 years (mean age 65 years). In presymptomatic D-CAA, only GFAP in CSF (7.7*103pg/mL vs. 4.4*103pg/mL in controls; P<.001) was increased compared to controls. In symptomatic D-CAA, both serum (NFL:26.2pg/mL vs. 12.5pg/mL; P=0.008, GFAP:130.8pg/mL vs. 123.4pg/mL; P=0.027) and CSF (NFL:16.8*102pg/mL vs. 7.8*102pg/mL; P=0.01 and GFAP:11.4*103pg/mL vs. 7.5*103pg/mL; P<.001) levels were higher than in controls and serum levels (NFL:26.2pg/mL vs. 6.7pg/mL; P=0.05 and GFAP:130.8pg/mL vs. 66.0pg/mL; P=0.004) were higher than in pre-symptomatic D-CAA. In sCAA, only NFL levels were increased compared to controls in both serum (25.6pg/mL vs. 12.5pg/mL; P=0.005) and CSF (20.0*102pg/mL vs 7.8*102pg/mL; P=0.008). All levels correlated with age. Serum NFL correlated with MoCA (P=0.008) and CAA-CSVD score (P<.001). NFL and GFAP in CSF correlated with Aβ42 levels (P=0.01/0.02). CONCLUSIONS GFAP level in CSF is an early biomarker for CAA and is increased years before symptom onset. NFL and GFAP levels in serum and CSF are biomarkers for advanced CAA.
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Affiliation(s)
- Ingeborg Rasing
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Sabine Voigt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Emma A Koemans
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anna M de Kort
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thijs W van Harten
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellis S van Etten
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik W van Zwet
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - H Bea Kuiperij
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Floris H B M Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Louise van der Weerd
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Marcel M Verbeek
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
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Lei T, Yang Z, Li H, Qin M, Gao H. Interactions between nanoparticles and pathological changes of vascular in Alzheimer's disease. Adv Drug Deliv Rev 2024; 207:115219. [PMID: 38401847 DOI: 10.1016/j.addr.2024.115219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024]
Abstract
Emerging evidence suggests that vascular pathological changes play a pivotal role in the pathogenesis of Alzheimer's disease (AD). The dysfunction of the cerebral vasculature occurs in the early course of AD, characterized by alterations in vascular morphology, diminished cerebral blood flow (CBF), impairment of the neurovascular unit (NVU), vasculature inflammation, and cerebral amyloid angiopathy. Vascular dysfunction not only facilitates the influx of neurotoxic substances into the brain, triggering inflammation and immune responses but also hampers the efflux of toxic proteins such as Aβ from the brain, thereby contributing to neurodegenerative changes in AD. Furthermore, these vascular changes significantly impact drug delivery and distribution within the brain. Therefore, developing targeted delivery systems or therapeutic strategies based on vascular alterations may potentially represent a novel breakthrough in AD treatment. This review comprehensively examines various aspects of vascular alterations in AD and outlines the current interactions between nanoparticles and pathological changes of vascular.
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Affiliation(s)
- Ting Lei
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, West China School of Pharmacy, Mental Health Center and National Chengdu Center for Safety Evaluation of Drugs, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zixiao Yang
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, West China School of Pharmacy, Mental Health Center and National Chengdu Center for Safety Evaluation of Drugs, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hanmei Li
- School of Food and Biological Engineering, Chengdu University, Chengdu 610106, China
| | - Meng Qin
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, West China School of Pharmacy, Mental Health Center and National Chengdu Center for Safety Evaluation of Drugs, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Huile Gao
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, West China School of Pharmacy, Mental Health Center and National Chengdu Center for Safety Evaluation of Drugs, West China Hospital, Sichuan University, Chengdu 610041, China.
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Choi MCY, Law THP, Chen S, Cheung WSK, Yim C, Ng OKS, Au LWC, Mok VCT, Woo PYM. Case Report: Taxifolin for neurosurgery-associated early-onset cerebral amyloid angiopathy. Front Neurol 2024; 15:1360705. [PMID: 38566852 PMCID: PMC10985332 DOI: 10.3389/fneur.2024.1360705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/13/2024] [Indexed: 04/04/2024] Open
Abstract
Cases of iatrogenic cerebral amyloid angiopathy (CAA) have been increasingly reported recently, particularly those associated with neurosurgery. Preclinical studies have shown taxifolin to be promising for treating CAA. We describe a young 42-year-old man with a history of childhood traumatic brain injury that required a craniotomy for hematoma evacuation. He later presented with recurrent lobar intracerebral hemorrhage (ICH) decades later, which was histologically confirmed to be CAA. Serial 11C-Pittsburgh compound B positron emission tomography (11C-PiB-PET) imaging showed a 24% decrease in global standardized uptake value ratio (SUVR) at 10 months after taxifolin use. During this period, the patient experienced clinical improvement with improved consciousness and reduced recurrent ICH frequency, which may be partly attributable to the potential amyloid-β (Aβ) clearing the effect of taxifolin. However, this effect seemed to have diminished at 15 months, CAA should be considered in young patients presenting with recurrent lobar ICH with a history of childhood neurosurgery, and serial 11C-PiB-PET scans warrant further validation as a strategy for monitoring treatment response in CAA for candidate Aβ-clearing therapeutic agents such as taxifolin.
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Affiliation(s)
- Maxwell C. Y. Choi
- Department of Neurosurgery, Kwong Wah Hospital, Kowloon, Hong Kong SAR, China
| | - Tiffany H. P. Law
- Department of Neurosurgery, Kwong Wah Hospital, Kowloon, Hong Kong SAR, China
| | - Sirong Chen
- Research Department, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong SAR, China
| | - William S. K. Cheung
- Department of Nuclear Medicine and PET, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong SAR, China
| | - Carmen Yim
- Department of Neurosurgery, Kwong Wah Hospital, Kowloon, Hong Kong SAR, China
| | - Oliver K. S. Ng
- Department of Anatomical and Cellular Pathology, Kwong Wah Hospital, Kowloon, Hong Kong SAR, China
| | - Lisa W. C. Au
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Vincent C. T. Mok
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Peter Y. M. Woo
- Department of Neurosurgery, Kwong Wah Hospital, Kowloon, Hong Kong SAR, China
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Tsai HH, Liu CJ, Lee BC, Chen YF, Yen RF, Jeng JS, Tsai LK. Cerebral tau pathology in cerebral amyloid angiopathy. Brain Commun 2024; 6:fcae086. [PMID: 38638152 PMCID: PMC11024817 DOI: 10.1093/braincomms/fcae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/01/2024] [Accepted: 03/11/2024] [Indexed: 04/20/2024] Open
Abstract
Tau, a hallmark of Alzheimer's disease, is poorly characterized in cerebral amyloid angiopathy. We aimed to assess the clinico-radiological correlations between tau positron emission tomography scans and cerebral amyloid angiopathy. We assessed cerebral amyloid and hyperphosphorylated tau in patients with probable cerebral amyloid angiopathy (n = 31) and hypertensive small vessel disease (n = 27) using 11C-Pittsburgh compound B and 18F-T807 positron emission tomography. Multivariable regression models were employed to assess radio-clinical features related to cerebral tau pathology in cerebral amyloid angiopathy. Cerebral amyloid angiopathy exhibited a higher cerebral tau burden in the inferior temporal lobe [1.25 (1.17-1.42) versus 1.08 (1.05-1.22), P < 0.001] and all Braak stage regions of interest (P < 0.05) than hypertensive small vessel disease, although the differences were attenuated after age adjustment. Cerebral tau pathology was significantly associated with cerebral amyloid angiopathy-related vascular markers, including cortical superficial siderosis (β = 0.12, 95% confidence interval 0.04-0.21) and cerebral amyloid angiopathy score (β = 0.12, 95% confidence interval 0.03-0.21) after adjustment for age, ApoE4 status and whole cortex amyloid load. Tau pathology correlated significantly with cognitive score (Spearman's ρ=-0.56, P = 0.001) and hippocampal volume (-0.49, P = 0.007), even after adjustment. In conclusion, tau pathology is more frequent in sporadic cerebral amyloid angiopathy than in hypertensive small vessel disease. Cerebral amyloid angiopathy-related vascular pathologies, especially cortical superficial siderosis, are potential markers of cerebral tau pathology suggestive of concomitant Alzheimer's disease.
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Affiliation(s)
- Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Chia-Ju Liu
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Ya-Fang Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Jiann-Shing Jeng
- Department of Neurology, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Li-Kai Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei 100225, Taiwan
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Wheeler KV, Irimia A, Braskie MN. Using Neuroimaging to Study Cerebral Amyloid Angiopathy and Its Relationship to Alzheimer's Disease. J Alzheimers Dis 2024; 97:1479-1502. [PMID: 38306032 DOI: 10.3233/jad-230553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Cerebral amyloid angiopathy (CAA) is characterized by amyloid-β aggregation in the media and adventitia of the leptomeningeal and cortical blood vessels. CAA is one of the strongest vascular contributors to Alzheimer's disease (AD). It frequently co-occurs in AD patients, but the relationship between CAA and AD is incompletely understood. CAA may drive AD risk through damage to the neurovascular unit and accelerate parenchymal amyloid and tau deposition. Conversely, early AD may also drive CAA through cerebrovascular remodeling that impairs blood vessels from clearing amyloid-β. Sole reliance on autopsy examination to study CAA limits researchers' ability to investigate CAA's natural disease course and the effect of CAA on cognitive decline. Neuroimaging allows for in vivo assessment of brain function and structure and can be leveraged to investigate CAA staging and explore its associations with AD. In this review, we will discuss neuroimaging modalities that can be used to investigate markers associated with CAA that may impact AD vulnerability including hemorrhages and microbleeds, blood-brain barrier permeability disruption, reduced cerebral blood flow, amyloid and tau accumulation, white matter tract disruption, reduced cerebrovascular reactivity, and lowered brain glucose metabolism. We present possible areas for research inquiry to advance biomarker discovery and improve diagnostics.
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Affiliation(s)
- Koral V Wheeler
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina Del Rey, CA, USA
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, USC Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Department of Biomedical Engineering, Corwin D. Denney Research Center, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Meredith N Braskie
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina Del Rey, CA, USA
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Zhou G, Ye Q, Xu Y, He B, Wu L, Zhu G, Xie J, Yao L, Xiao Z. Mitochondrial calcium uptake 3 mitigates cerebral amyloid angiopathy-related neuronal death and glial inflammation by reducing mitochondrial dysfunction. Int Immunopharmacol 2023; 117:109614. [PMID: 36878048 DOI: 10.1016/j.intimp.2022.109614] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 12/10/2022] [Accepted: 12/16/2022] [Indexed: 03/06/2023]
Abstract
Cerebral amyloid angiopathy (CAA) is characterized by the cerebrovascular amyloid-β (Aβ) accumulation, and always accompanied by Alzheimer's disease (AD). Mitochondrial dysfunction-associated cellular events including cell death, inflammation and oxidative stress are implicated in the progression of CAA. Unfortunately, the molecular mechanisms revealing CAA pathogenesis are still obscure, thus requiring further studies. Mitochondrial calcium uptake 3 (MICU3), a regulator of the mitochondrial Ca2+ uniporter (MCU), mediates various biological functions, but its expression and influence on CAA are largely unknown. In the present study, we found that MICU3 expression was gradually declined in cortex and hippocampus of Tg-SwDI transgenic mice. Using stereotaxic operation with AAV9 encoding MICU3, we showed that AAV-MICU3 improved the behavioral performances and cerebral blood flow (CBF) in Tg-SwDI mice, along with markedly reduced Aβ deposition through mediating Aβ metabolism process. Importantly, we found that AAV-MICU3 remarkably improved neuronal death and mitigated glial activation and neuroinflammation in cortex and hippocampus of Tg-SwDI mice. Furthermore, excessive oxidative stress, mitochondrial impairment and dysfunction, decreased ATP and mitochondrial DNA (mtDNA) were detected in Tg-SwDI mice, while being considerably ameliorated upon MICU3 over-expression. More importantly, our in vitro experiments suggested that MICU3-attenuated neuronal death, activation of glial cells and oxidative stress were completely abrogated upon PTEN induced putative kinase 1 (PINK1) knockdown, indicating that PINK1 was required for MICU3 to perform its protective effects against CAA. Mechanistic experiment confirmed an interaction between MICU3 and PINK1. Together, these findings demonstrated that MICU3-PINK1 axis may serve as a key target for CAA treatment mainly through improving mitochondrial dysfunction.
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Affiliation(s)
- Guijuan Zhou
- Department of Neurology, the First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, Hunan, PR China; Department of Rehabilitation Medicine, the First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, Hunan, PR China
| | - Qing Ye
- Department of Neurology, the First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, Hunan, PR China
| | - Yan Xu
- Department of Neurology, the First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, Hunan, PR China
| | - Bing He
- Department of Neurology, the First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, Hunan, PR China
| | - Lin Wu
- Department of Neurology, the First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, Hunan, PR China
| | - Guanghua Zhu
- Department of Neurology, the First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, Hunan, PR China
| | - Juan Xie
- Department of Neurology, the First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, Hunan, PR China
| | - Lan Yao
- Department of Neurology, the First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, Hunan, PR China
| | - Zijian Xiao
- Department of Neurology, the First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, Hunan, PR China.
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Chen Zhou ZH, Salvador Álvarez E, Hilario Barrio A, Cárdenas Del Carre AM, Romero Coronado J, Ramos González A. Primary and secondary non-traumatic intra-cerebral haemorrhage: MRI findings. RADIOLOGÍA (ENGLISH EDITION) 2023; 65:149-164. [PMID: 37059580 DOI: 10.1016/j.rxeng.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/02/2023] [Indexed: 04/03/2023]
Abstract
Intracranial haemorrhage (ICH) accounts for 10-30% of strokes, being the form with the worst prognosis. The causes of cerebral haemorrhage can be both primary, mainly hypertensive and amyloid angiopathy, and secondary, such as tumours or vascular lesions. Identifying the aetiology of bleeding is essential since it determines the treatment to be performed and the patient's prognosis. The main objective of this review is to review the main magnetic resonance imaging (MRI) findings of the primary and secondary causes of ICH, focusing on those radiological signs that help guide bleeding due to primary angiopathy or secondary to an underlying lesion. The indications for MRI in the event of non-traumatic intracranial haemorrhage will also be reviewed.
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Affiliation(s)
- Z H Chen Zhou
- Departamento de Radiodiagnóstico, Sección de Neuroradiología, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - E Salvador Álvarez
- Departamento de Radiodiagnóstico, Sección de Neuroradiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Hilario Barrio
- Departamento de Radiodiagnóstico, Sección de Neuroradiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A M Cárdenas Del Carre
- Departamento de Radiodiagnóstico, Sección de Neuroradiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Romero Coronado
- Departamento de Radiodiagnóstico, Sección de Neuroradiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Ramos González
- Departamento de Radiodiagnóstico, Sección de Neuroradiología, Hospital Universitario 12 de Octubre, Madrid, Spain
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Chen Zhou Z, Salvador Álvarez E, Hilario Barrio A, María Cárdenas del Carre A, Romero Coronado J, Ramos González A. Hemorragia cerebral primaria y secundaria no traumática: Hallazgos en RM. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Nagaraja N, Wang WE, Duara R, DeKosky ST, Vaillancourt D. Mediation of Reduced Hippocampal Volume by Cerebral Amyloid Angiopathy in Pathologically Confirmed Patients with Alzheimer's Disease. J Alzheimers Dis 2023; 93:495-507. [PMID: 37038809 DOI: 10.3233/jad-220624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND Hippocampal atrophy in cerebral amyloid angiopathy (CAA) has been reported to be similar to that in Alzheimer's disease (AD). OBJECTIVE To evaluate if CAA pathology partly mediates reduced hippocampal volume in patients with AD. METHODS Patients with a clinical diagnosis of AD and neuropathological confirmation of AD+/-CAA in the National Alzheimer's Coordinating Center database were included in the study. The volumes of temporal lobe structures were calculated on T1-weighted imaging (T1-MRI) using automated FreeSurfer software, from images acquired on average 5 years prior to death. Multivariate regression analysis was performed to compare brain volumes in four CAA groups. The hippocampal volume on T1-MRI was correlated with Clinical Dementia Rating sum of boxes (CDRsb) score, apolipoprotein E (APOE) genotype, and hippocampal atrophy at autopsy. RESULTS The study included 231 patients with no (n = 45), mild (n = 70), moderate (n = 67), and severe (n = 49) CAA. Among the four CAA groups, patients with severe CAA had a smaller mean left hippocampal volume (p = 0.023) but this was not significant when adjusted for APOE ɛ4 (p = 0.07). The left hippocampal volume on MRI correlated significantly with the hippocampal atrophy grading on neuropathology (p = 0.0003). Among patients with severe CAA, the left hippocampal volume on T1-MRI: (a) decreased with an increase in the number of APOE ɛ4 alleles (p = 0.04); but (b) had no evidence of correlation with CDRsb score (p = 0.57). CONCLUSION Severe CAA was associated with smaller left hippocampal volume on T1-MRI up to five years prior to death among patients with neuropathologically confirmed AD. This relationship was dependent on APOE ɛ4 genotype.
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Affiliation(s)
- Nandakumar Nagaraja
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Wei-En Wang
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Ranjan Duara
- Department of Neurology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Steven T DeKosky
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
- McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - David Vaillancourt
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
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12
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Durrani R, Wang M, Cox E, Irving E, Saad F, McCreary CR, Beaudin AE, Gee M, Nelles K, Sajobi TT, Ismail Z, Camicioli R, Smith EE. Mediators of cognitive impairment in cerebral amyloid angiopathy. Int J Stroke 2023; 18:78-84. [PMID: 35473418 DOI: 10.1177/17474930221099352] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) is associated with cognitive decline. CAA has diverse impacts on brain structure and function; however, the brain lesions that mediate the association of CAA with cognition are not understood well. AIMS To determine the degree to which CAA neuroimaging biomarkers mediate the association of CAA with cognitive dysfunction. METHODS We analyzed cross-sectional data of patients with probable CAA and controls without cognitive impairment from the Functional Assessment of Vascular Reactivity study. Neuropsychological tests were grouped into domains of memory, executive function, and processing speed. Candidate CAA neuroimaging biomarkers were pre-specified based on prior literature, consisting of white matter hyperintensity volume, peak width of skeletonized mean diffusivity (PSMD) on diffusion tensor magnetic resonance imaging (MRI), cerebrovascular reactivity (CVR), cortical thickness, and cortical thickness in a meta-region of interest typically affected by Alzheimer's disease (AD). Cognitive scores and neuroimaging markers were standardized and reported in relation to values in controls. Mediation analysis was used to estimate the total effect of CAA on cognition and the proportion of the total effect that was mediated by neuroimaging biomarkers, controlling for age, sex, and education. RESULTS There were 131 participants (67 CAA and 64 controls). Mean age was 72.1 ± 7.7 years, and 54.2% were women. As expected, compared to controls, CAA was associated with lower cognition. In mediation analyses, CAA had direct unmediated effects of 48%, 46%, and 52% on all three cognitive domains. The association of CAA with memory was partially mediated by CVR and PSMD, accounting for 18% and 36% of the total effect of CAA. The association of CAA with executive function was partially mediated by PSMD and mean cortical thickness in the AD meta-region of interest (ROI), accounting for 33% and 31% of the total effect of CAA. The association of CAA with processing speed was partially mediated by CVR and PSMD, accounting for 8% and 34% of the total effect of CAA. Among CAA participants, the presence of cortical superficial siderosis was associated with lower processing speed. CONCLUSION Altered white matter diffusivity (i.e. PSMD), CVR, and atrophy, taken together, account for about half the effect of CAA on cognition.
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Affiliation(s)
- Romella Durrani
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Meng Wang
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Emily Cox
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Elisabeth Irving
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Feryal Saad
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Cheryl R McCreary
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Andrew E Beaudin
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Myrlene Gee
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Krista Nelles
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Zahinoor Ismail
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada.,Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Richard Camicioli
- Department of Medicine, Division of Neurology and Neuroscience and Mental Health Institute (NMHI), University of Alberta, Edmonton, AB, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada
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13
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Cerebral Superficial Siderosis. Clin Neuroradiol 2022; 33:293-306. [DOI: 10.1007/s00062-022-01231-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022]
Abstract
AbstractSuperficial siderosis (SS) of the central nervous system constitutes linear hemosiderin deposits in the leptomeninges and the superficial layers of the cerebrum and the spinal cord. Infratentorial (i) SS is likely due to recurrent or continuous slight bleeding into the subarachnoid space. It is assumed that spinal dural pathologies often resulting in cerebrospinal fluid (CSF) leakage is the most important etiological group which causes iSS and detailed neuroradiological assessment of the spinal compartment is necessary. Further etiologies are neurosurgical interventions, trauma and arteriovenous malformations. Typical neurological manifestations of this classical type of iSS are slowly progressive sensorineural hearing impairment and cerebellar symptoms, such as ataxia, kinetic tremor, nystagmus and dysarthria. Beside iSS, a different type of SS restricted to the supratentorial compartment can be differentiated, i.e. cortical (c) SS, especially in older people often due to cerebral amyloid angiopathy (CAA). Clinical presentation of cSS includes transient focal neurological episodes or “amyloid spells”. In addition, spontaneous and amyloid beta immunotherapy-associated CAA-related inflammation may cause cSS, which is included in the hemorrhagic subgroup of amyloid-related imaging abnormalities (ARIA). Because a definitive diagnosis requires a brain biopsy, knowledge of neuroimaging features and clinical findings in CAA-related inflammation is essential. This review provides neuroradiological hallmarks of the two groups of SS and give an overview of neurological symptoms and differential diagnostic considerations.
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14
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Charidimou A, Boulouis G, Frosch MP, Baron JC, Pasi M, Albucher JF, Banerjee G, Barbato C, Bonneville F, Brandner S, Calviere L, Caparros F, Casolla B, Cordonnier C, Delisle MB, Deramecourt V, Dichgans M, Gokcal E, Herms J, Hernandez-Guillamon M, Jäger HR, Jaunmuktane Z, Linn J, Martinez-Ramirez S, Martínez-Sáez E, Mawrin C, Montaner J, Moulin S, Olivot JM, Piazza F, Puy L, Raposo N, Rodrigues MA, Roeber S, Romero JR, Samarasekera N, Schneider JA, Schreiber S, Schreiber F, Schwall C, Smith C, Szalardy L, Varlet P, Viguier A, Wardlaw JM, Warren A, Wollenweber FA, Zedde M, van Buchem MA, Gurol ME, Viswanathan A, Al-Shahi Salman R, Smith EE, Werring DJ, Greenberg SM. The Boston criteria version 2.0 for cerebral amyloid angiopathy: a multicentre, retrospective, MRI-neuropathology diagnostic accuracy study. Lancet Neurol 2022; 21:714-725. [PMID: 35841910 PMCID: PMC9389452 DOI: 10.1016/s1474-4422(22)00208-3] [Citation(s) in RCA: 211] [Impact Index Per Article: 105.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) is an age-related small vessel disease, characterised pathologically by progressive deposition of amyloid β in the cerebrovascular wall. The Boston criteria are used worldwide for the in-vivo diagnosis of CAA but have not been updated since 2010, before the emergence of additional MRI markers. We report an international collaborative study aiming to update and externally validate the Boston diagnostic criteria across the full spectrum of clinical CAA presentations. METHODS In this multicentre, hospital-based, retrospective, MRI and neuropathology diagnostic accuracy study, we did a retrospective analysis of clinical, radiological, and histopathological data available to sites participating in the International CAA Association to formulate updated Boston criteria and establish their diagnostic accuracy across different populations and clinical presentations. Ten North American and European academic medical centres identified patients aged 50 years and older with potential CAA-related clinical presentations (ie, spontaneous intracerebral haemorrhage, cognitive impairment, or transient focal neurological episodes), available brain MRI, and histopathological assessment for CAA diagnosis. MRI scans were centrally rated at Massachusetts General Hospital (Boston, MA, USA) for haemorrhagic and non-haemorrhagic CAA markers, and brain tissue samples were rated by neuropathologists at the contributing sites. We derived the Boston criteria version 2.0 (v2.0) by selecting MRI features to optimise diagnostic specificity and sensitivity in a prespecified derivation cohort (Boston cases 1994-2012, n=159), then externally validated the criteria in a prespecified temporal validation cohort (Boston cases 2012-18, n=59) and a geographical validation cohort (non-Boston cases 2004-18; n=123), comparing accuracy of the new criteria to the currently used modified Boston criteria with histopathological assessment of CAA as the diagnostic standard. We also assessed performance of the v2.0 criteria in patients across all cohorts who had the diagnostic gold standard of brain autopsy. FINDINGS The study protocol was finalised on Jan 15, 2017, patient identification was completed on Dec 31, 2018, and imaging analyses were completed on Sept 30, 2019. Of 401 potentially eligible patients presenting to Massachusetts General Hospital, 218 were eligible to be included in the analysis; of 160 patient datasets from other centres, 123 were included. Using the derivation cohort, we derived provisional criteria for probable CAA requiring the presence of at least two strictly lobar haemorrhagic lesions (ie, intracerebral haemorrhages, cerebral microbleeds, or foci of cortical superficial siderosis) or at least one strictly lobar haemorrhagic lesion and at least one white matter characteristic (ie, severe visible perivascular spaces in centrum semiovale or white matter hyperintensities in a multispot pattern). The sensitivity and specificity of these criteria were 74·8% (95% CI 65·4-82·7) and 84·6% (71·9-93·1) in the derivation cohort, 92·5% (79·6-98·4) and 89·5% (66·9-98·7) in the temporal validation cohort, 80·2% (70·8-87·6) and 81·5% (61·9-93·7) in the geographical validation cohort, and 74·5% (65·4-82·4) and 95·0% (83·1-99·4) in all patients who had autopsy as the diagnostic standard. The area under the receiver operating characteristic curve (AUC) was 0·797 (0·732-0·861) in the derivation cohort, 0·910 (0·828-0·992) in the temporal validation cohort, 0·808 (0·724-0·893) in the geographical validation cohort, and 0·848 (0·794-0·901) in patients who had autopsy as the diagnostic standard. The v2.0 Boston criteria for probable CAA had superior accuracy to the current Boston criteria (sensitivity 64·5% [54·9-73·4]; specificity 95·0% [83·1-99·4]; AUC 0·798 [0·741-0854]; p=0·0005 for comparison of AUC) across all individuals who had autopsy as the diagnostic standard. INTERPRETATION The Boston criteria v2.0 incorporate emerging MRI markers of CAA to enhance sensitivity without compromising their specificity in our cohorts of patients aged 50 years and older presenting with spontaneous intracerebral haemorrhage, cognitive impairment, or transient focal neurological episodes. Future studies will be needed to determine generalisability of the v.2.0 criteria across the full range of patients and clinical presentations. FUNDING US National Institutes of Health (R01 AG26484).
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Affiliation(s)
- Andreas Charidimou
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | - Gregoire Boulouis
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France
| | - Matthew P Frosch
- C S Kubik Laboratory of Neuropathology, Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Jean-Claude Baron
- Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France; GHU Psychiatrie et Neurosciences, site Sainte-Anne, Paris, France
| | - Marco Pasi
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Jean Francois Albucher
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Gargi Banerjee
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Carmen Barbato
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Fabrice Bonneville
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Sebastian Brandner
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Lionel Calviere
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - François Caparros
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Barbara Casolla
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Charlotte Cordonnier
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Marie-Bernadette Delisle
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Vincent Deramecourt
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Ludwig-Maximilians University Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy) and German Center for Neurodegenerative Diseases, Munich, Germany
| | - Elif Gokcal
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jochen Herms
- Center for Neuropathology and Prion Research, Ludwig-Maximilians University Munich, Munich, Germany
| | - Mar Hernandez-Guillamon
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hans Rolf Jäger
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Zane Jaunmuktane
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Jennifer Linn
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Dresden, Germany
| | - Sergi Martinez-Ramirez
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Framingham Heart Study and Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Elena Martínez-Sáez
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christian Mawrin
- Departments of Neuropathology, Neurosurgery, and Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Joan Montaner
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Institute of Biomedicine of Seville, Hospital Universitario Virgen Macarena, Consejo Superior de Investigaciones Científicas, University of Seville, Spain
| | - Solene Moulin
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Jean-Marc Olivot
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Fabrizio Piazza
- CAA and AD Translational Research and Biomarkers Laboratory, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Laurent Puy
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Nicolas Raposo
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Mark A Rodrigues
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Sigrun Roeber
- Center for Neuropathology and Prion Research, Ludwig-Maximilians University Munich, Munich, Germany
| | - Jose Rafael Romero
- Framingham Heart Study and Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | | | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Stefanie Schreiber
- Departments of Neuropathology, Neurosurgery, and Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Frank Schreiber
- Departments of Neuropathology, Neurosurgery, and Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Corentin Schwall
- Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France; GHU Psychiatrie et Neurosciences, site Sainte-Anne, Paris, France
| | - Colin Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Levente Szalardy
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Pascale Varlet
- Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France; GHU Psychiatrie et Neurosciences, site Sainte-Anne, Paris, France
| | - Alain Viguier
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew Warren
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Frank A Wollenweber
- Institute for Stroke and Dementia Research, Ludwig-Maximilians University Munich, Munich, Germany; Helios Dr Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Marialuisa Zedde
- Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - M Edip Gurol
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Steven M Greenberg
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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15
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Best JG, Cardus B, Klijn CJM, Lip G, Seiffge DJ, Smith EE, Werring DJ. Antithrombotic dilemmas in stroke medicine: new data, unsolved challenges. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2020-325249. [PMID: 35728935 DOI: 10.1136/jnnp-2020-325249] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 05/16/2022] [Indexed: 11/04/2022]
Abstract
Antithrombotic therapy is a key element of secondary prevention in patients who have had an ischaemic stroke or transient ischaemic attack. However, its use in clinical practice is not always straightforward. This review provides an update on certain difficult scenarios in antithrombotic management, with a focus on recent clinical trials and large observational studies. We discuss the approach to patients with an indication for antithrombotic treatment who also have clinical or radiological evidence of previous intracranial bleeding, patients with indications for both anticoagulant and antiplatelet treatment, and patients in whom antithrombotic treatment fails to prevent stroke. We also review the timing of anticoagulation initiation after cardioembolic stroke, and the use of antithrombotics in patients with asymptomatic cerebrovascular disease. Despite a wealth of new evidence, numerous uncertainties remain and we highlight ongoing trials addressing these.
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Affiliation(s)
- Jonathan G Best
- Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Beatrix Cardus
- Royal Surrey County Hospital, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Catharina J M Klijn
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Gregory Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - David J Seiffge
- Department of Neurology, Inselspital University Hospital, Bern, Switzerland
| | - Eric E Smith
- Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - David J Werring
- Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
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16
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Charidimou A. Cerebrospinal Fluid Biomarkers for Cerebral Amyloid Angiopathy Diagnosis. J Alzheimers Dis 2022; 87:803-805. [PMID: 35527557 DOI: 10.3233/jad-220133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An accurate diagnosis of sporadic cerebral amyloid angiopathy (CAA) is critical for patient management and research (including clinical trials) for this common small vessel pathology of the brain. While the "big bang" of the CAA field has been the device and wide adoption of the clinico-radiological Boston criteria which allowed for CAA diagnosis during life, these criteria are not without major shortcoming. As it is now becoming evident that CAA is probably not a single disease, but rather represents divergent pathophysiological phenotypes and clinical trajectories, new biomarker-driven diagnostic approaches should be sought. One such complimentary approach for CAA diagnosis is the use of cerebrospinal fluid biomarkers (CSF), which could provide dynamic measures of the underlying disease process and is discussed in this commentary given exciting new advances. A hint on how the practicing clinician could apply the current CSF data for CAA diagnosis is also provided.
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Affiliation(s)
- Andreas Charidimou
- Department of Neurology, Boston University Medical Center and Boston University School of Medicine, Boston, MA, USA
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17
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Vargas-George S, Dave KR. Models of cerebral amyloid angiopathy-related intracerebral hemorrhage. BRAIN HEMORRHAGES 2022. [DOI: 10.1016/j.hest.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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18
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Grangeon L, Paquet C, Guey S, Zarea A, Martinaud O, Rotharmel M, Maltête D, Quillard-Muraine M, Nicolas G, Charbonnier C, Chabriat H, Wallon D. Cerebrospinal Fluid Profile of Tau, Phosphorylated Tau, Aβ42, and Aβ40 in Probable Cerebral Amyloid Angiopathy. J Alzheimers Dis 2022; 87:791-802. [DOI: 10.3233/jad-215208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: There is no consensus regarding the diagnostic value of cerebrospinal fluid (CSF) Alzheimer’s disease (AD) biomarkers in cerebral amyloid angiopathy (CAA). Objective: To describe the CSF levels of Aβ 42, Aβ 40, total protein Tau, and phosphorylated-Tau (p-Tau) in a large series of probable CAA patients and to compare with AD patients in order to identify a specific pattern in CAA but also to look for correlations with the neuroimaging profile. Methods: We retrospectively included from 2 French centers probable CAA patients according to modified Boston criteria who underwent lumbar puncture (LP) with CSF AD biomarker quantifications. Two neurologists independently analyzed all MRI sequences. A logistic regression and Spearman’s correlation coefficient were used to identify correlation between MRI and CSF biomarkers in CAA. Results: We included 63 probable CAA and 27 AD patients. Among CAA 50.8% presented with decreased Aβ 42 level associated with elevated p-Tau and/or Tau, 34.9% with isolated decreased Aβ 42 level and 14.3% patients with normal Aβ 42 level. Compared to AD, CAA showed lower levels of Tau (p = 0.008), p-Tau (p = 0.004), and Aβ 40 (p = 0.001) but similar Aβ 42 level (p = 0.07). No correlation between Aβ 42 or Aβ 40 levels and neuroimaging was found. Conclusion: CSF biomarkers may improve the accuracy of the modified Boston criteria with altered profile in 85% of the patients fulfilling revised Boston criteria for probable CAA. Aβ 40 appears as an interesting selective biomarker in differential diagnosis.
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Affiliation(s)
- Lou Grangeon
- Normandie Univ, UNIROUEN, Inserm U1245 and CHURouen, Department of Neurology and CNR-MAJ, Normandy Center for Genomic and Personalized Medicine, Rouen, France
| | - Claire Paquet
- CMRR Paris Nord AP-HP, Groupe Hospitalier Lariboisière Fernand-Widal Saint-Louis, INSERM, U942, Université Paris Diderot, Sorbonne Paris Cité, UMRS 942, France
| | - Stéphanie Guey
- Department of Neurology, AP-HP, Groupe Hospitalier Lariboisière Fernand-Widal Saint-Louis, Paris, France
| | - Aline Zarea
- Normandie Univ, UNIROUEN, Inserm U1245 and CHURouen, Department of Neurology and CNR-MAJ, Normandy Center for Genomic and Personalized Medicine, Rouen, France
| | | | - Maud Rotharmel
- Rouvray Hospital of Rouen, University Department of Psychiatry, France
| | - David Maltête
- Normandie Univ, UNIROUEN, Inserm U1245 and CHURouen, Department of Neurology and CNR-MAJ, Normandy Center for Genomic and Personalized Medicine, Rouen, France
| | | | - Gael Nicolas
- Normandie Univ, UNIROUEN, Inserm U1245 and CHU Rouen, Department of Genetics and CNR-MAJ, Normandy Center for Genomic and Personalized Medicine, Rouen, France
| | - Camille Charbonnier
- Normandie Univ, UNIROUEN, Inserm U1245 and CHU Rouen, Department of Genetics and CNR-MAJ, Normandy Center for Genomic and Personalized Medicine, Rouen, France
| | - Hugues Chabriat
- Department of Neurology, AP-HP, Groupe Hospitalier Lariboisière Fernand-Widal Saint-Louis, Paris, France
| | - David Wallon
- Normandie Univ, UNIROUEN, Inserm U1245 and CHURouen, Department of Neurology and CNR-MAJ, Normandy Center for Genomic and Personalized Medicine, Rouen, France
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19
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Palinopsia as an initial symptom of cerebral amyloid angiopathy-related inflammation. eNeurologicalSci 2021; 25:100375. [PMID: 34765753 PMCID: PMC8571695 DOI: 10.1016/j.ensci.2021.100375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/06/2021] [Accepted: 10/24/2021] [Indexed: 12/02/2022] Open
Abstract
We report the first case of cerebral amyloid angiopathy-related inflammation (CAA-RI) presenting palinopsia initially. Palinopsia is generally caused by intracranial diseases involving the parietal and occipital areas. CAA dominantly affects parietal and occipital lobes, therefore palinopsia could be an important phenomenon of the disease.
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20
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Irizarry BA, Davis J, Zhu X, Boon BDC, Rozemuller AJM, Van Nostrand WE, Smith SO. Human cerebral vascular amyloid contains both antiparallel and parallel in-register Aβ40 fibrils. J Biol Chem 2021; 297:101259. [PMID: 34599967 PMCID: PMC8528725 DOI: 10.1016/j.jbc.2021.101259] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 09/19/2021] [Accepted: 09/27/2021] [Indexed: 01/02/2023] Open
Abstract
The accumulation of fibrillar amyloid-β (Aβ) peptides alongside or within the cerebral vasculature is the hallmark of cerebral amyloid angiopathy (CAA). This condition commonly co-occurs with Alzheimer's disease (AD) and leads to cerebral microbleeds, intracranial hemorrhages, and stroke. CAA also occurs sporadically in an age-dependent fashion and can be accelerated by the presence of familial Aβ mutant peptides. Recent studies using Fourier transform infrared (FTIR) spectroscopy of vascular Aβ fibrils derived from rodents containing the double E22Q/D23N mutations indicated the presence of a novel antiparallel β-sheet structure. To address whether this structure is associated solely with the familial mutations or is a common feature of CAA, we propagated Aβ fibrils from human brain vascular tissue of patients diagnosed with nonfamilial CAA. Aβ fibrils were isolated from cerebral blood vessels using laser capture microdissection in which specific amyloid deposits were removed from thin slices of the brain tissue. Transmission electron microscopy revealed that these deposits were organized into a tight meshwork of fibrils, which FTIR measurements showed could serve as seeds to propagate the growth of Aβ40 fibrils for structural studies. Solid-state NMR measurements of the fibrils propagated from vascular amyloid showed they contained a mixture of parallel, in-register, and antiparallel β-sheet structures. The presence of fibrils with antiparallel structure derived from vascular amyloid is distinct from the typical parallel, in-register β-sheet structure that appears in fibrils derived from parenchymal amyloid in AD. These observations reveal that different microenvironments influence the structures of Aβ fibrils in the human brain.
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Affiliation(s)
- Brandon A Irizarry
- Center for Structural Biology, Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, New York, USA
| | - Judianne Davis
- George and Anne Ryan Institute for Neuroscience, Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Xiaoyue Zhu
- George and Anne Ryan Institute for Neuroscience, Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Baayla D C Boon
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - VUmc, Amsterdam, the Netherlands; Department of Pathology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - VUmc, Amsterdam, the Netherlands
| | - Annemieke J M Rozemuller
- Department of Pathology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - VUmc, Amsterdam, the Netherlands
| | - William E Van Nostrand
- George and Anne Ryan Institute for Neuroscience, Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Steven O Smith
- Center for Structural Biology, Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, New York, USA.
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21
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Cerebrospinal fluid metallomics in cerebral amyloid angiopathy: an exploratory analysis. J Neurol 2021; 269:1470-1475. [PMID: 34292397 PMCID: PMC8857160 DOI: 10.1007/s00415-021-10711-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/22/2022]
Abstract
Introduction Cerebral amyloid angiopathy (CAA) is associated with symptomatic intracerebral haemorrhage. Biomarkers of clinically silent bleeding events, such as cerebrospinal fluid (CSF) ferritin and iron, might provide novel measures of disease presence and severity. Methods We performed an exploratory study comparing CSF iron, ferritin, and other metal levels in patients with CAA, control subjects (CS) and patients with Alzheimer’s disease (AD). Ferritin was measured using a latex fixation test; metal analyses were performed using inductively coupled plasma mass spectrometry. Results CAA patients (n = 10) had higher levels of CSF iron than the AD (n = 20) and CS (n = 10) groups (medians 23.42, 15.48 and 17.71 μg/L, respectively, p = 0.0015); the difference between CAA and AD groups was significant in unadjusted and age-adjusted analyses. We observed a difference in CSF ferritin (medians 10.10, 7.77 and 8.01 ng/ml, for CAA, AD and CS groups, respectively, p = 0.01); the difference between the CAA and AD groups was significant in unadjusted, but not age-adjusted, analyses. We also observed differences between the CAA and AD groups in CSF nickel and cobalt (unadjusted analyses). Conclusions In this exploratory study, we provide preliminary evidence for a distinct CSF metallomic profile in patients with CAA. Replication and validation of these results in larger cohorts is needed. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10711-6.
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22
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Fotiadis P, Pasi M, Charidimou A, Warren AD, Schwab KM, Rosand J, van der Grond J, van Buchem MA, Viswanathan A, Gurol ME, Greenberg SM. Decreased Basal Ganglia Volume in Cerebral Amyloid Angiopathy. J Stroke 2021; 23:223-233. [PMID: 34102757 PMCID: PMC8189850 DOI: 10.5853/jos.2020.04280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background and Purpose Cerebral amyloid angiopathy (CAA) is a common pathology of the leptomeningeal and cortical small vessels associated with hemorrhagic and non-hemorrhagic brain injury. Given previous evidence for CAA-related loss of cortical thickness and white matter volume, we hypothesized that CAA might also cause tissue loss in the basal ganglia.
Methods We compared basal ganglia volumes expressed as a percentage of total intracranial volume (pBGV) of non-demented patients with sporadic and hereditary CAA to age-matched healthy control (HC) and Alzheimer’s disease (AD) cohorts.
Results Patients with sporadic CAA had lower pBGV (n=80, 1.16%±0.14%) compared to HC (n=80, 1.30%±0.13%, P<0.0001) and AD patients (n=80, 1.23%±0.11%, P=0.001). Similarly, patients with hereditary CAA demonstrated lower pBGV (n=25, 1.26%±0.17%) compared to their matched HC (n=25, 1.36%±0.15%, P=0.036). Using a measurement of normalized basal ganglia width developed for analysis of clinical-grade magnetic resonance images, we found smaller basal ganglia width in patients with CAA-related lobar intracerebral hemorrhage (ICH; n=93, 12.35±1.47) compared to age-matched patients with hypertension-related deep ICH (n=93, 13.46±1.51, P<0.0001) or HC (n=93, 15.45±1.22, P<0.0001). Within the sporadic CAA research cohort, decreased basal ganglia volume was independently correlated with greater cortical gray matter atrophy (r=0.45, P<0.0001), increased basal ganglia fractional anisotropy (r=–0.36, P=0.001), and worse performance on language processing (r=0.35, P=0.003), but not with cognitive tests of executive function or processing speed.
Conclusions These findings suggest an independent effect of CAA on basal ganglia tissue loss, indicating a novel mechanism for CAA-related brain injury and neurologic dysfunction.
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Affiliation(s)
- Panagiotis Fotiadis
- Department of Neurology, J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marco Pasi
- Department of Neurology, J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Stroke Unit, Department of Neurology, University of Lille, INSERM U1171, CHU Lille, Lille, France
| | - Andreas Charidimou
- Department of Neurology, J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew D Warren
- Department of Neurology, J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin M Schwab
- Department of Neurology, J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Jonathan Rosand
- Department of Neurology, J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anand Viswanathan
- Department of Neurology, J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Edip Gurol
- Department of Neurology, J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Department of Neurology, J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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23
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Jäkel L, De Kort AM, Klijn CJM, Schreuder FHBM, Verbeek MM. Prevalence of cerebral amyloid angiopathy: A systematic review and meta-analysis. Alzheimers Dement 2021; 18:10-28. [PMID: 34057813 PMCID: PMC9290643 DOI: 10.1002/alz.12366] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 01/05/2023]
Abstract
Reported prevalence estimates of sporadic cerebral amyloid angiopathy (CAA) vary widely. CAA is associated with cognitive dysfunction and intracerebral hemorrhage, and linked to immunotherapy‐related side‐effects in Alzheimer's disease (AD). Given ongoing efforts to develop AD immunotherapy, accurate estimates of CAA prevalence are important. CAA can be diagnosed neuropathologically or during life using MRI markers including strictly lobar microbleeds. In this meta‐analysis of 170 studies including over 73,000 subjects, we show that in patients with AD, CAA prevalence based on pathology (48%) is twice that based on presence of strictly lobar cerebral microbleeds (22%); in the general population this difference is three‐fold (23% vs 7%). Both methods yield similar estimated prevalences of CAA in cognitively normal elderly (5% to 7%), in patients with intracerebral hemorrhage (19% to 24%), and in patients with lobar intracerebral hemorrhage (50% to 57%). However, we observed large heterogeneity among neuropathology and MRI protocols, which calls for standardized assessment and reporting of CAA.
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Affiliation(s)
- Lieke Jäkel
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands
| | - Anna M De Kort
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands
| | - Floris H B M Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands
| | - Marcel M Verbeek
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands.,Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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24
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Smith EE, Charidimou A, Ayata C, Werring DJ, Greenberg SM. Cerebral Amyloid Angiopathy-Related Transient Focal Neurologic Episodes. Neurology 2021; 97:231-238. [PMID: 34016709 PMCID: PMC8356377 DOI: 10.1212/wnl.0000000000012234] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/19/2021] [Indexed: 12/22/2022] Open
Abstract
Transient focal neurologic episodes (TFNEs) are brief disturbances in motor, somatosensory, visual, or language functions that can occur in patients with cerebral amyloid angiopathy (CAA) and may be difficult to distinguish from TIAs or other transient neurologic syndromes. They herald a high rate of future lobar intracerebral hemorrhage, making it imperative to differentiate them from TIAs to avoid potentially dangerous use of antithrombotic drugs. Cortical spreading depression or depolarization triggered by acute or chronic superficial brain bleeding, a contributor to brain injury in other neurologic diseases, may be the underlying mechanism. This review discusses diagnosis, pathophysiology, and management of CAA-related TFNEs.
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Affiliation(s)
- Eric E Smith
- From the Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Hemorrhagic Stroke Research Program (A.C., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School; Stroke Service and Neurovascular Research Lab (C.A.), Department of Neurology, Massachusetts General Hospital, Boston; and Stroke Research Centre (D.J.W.), University College London Queen Square Institute of Neurology, UK.
| | - Andreas Charidimou
- From the Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Hemorrhagic Stroke Research Program (A.C., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School; Stroke Service and Neurovascular Research Lab (C.A.), Department of Neurology, Massachusetts General Hospital, Boston; and Stroke Research Centre (D.J.W.), University College London Queen Square Institute of Neurology, UK
| | - Cenk Ayata
- From the Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Hemorrhagic Stroke Research Program (A.C., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School; Stroke Service and Neurovascular Research Lab (C.A.), Department of Neurology, Massachusetts General Hospital, Boston; and Stroke Research Centre (D.J.W.), University College London Queen Square Institute of Neurology, UK
| | - David J Werring
- From the Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Hemorrhagic Stroke Research Program (A.C., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School; Stroke Service and Neurovascular Research Lab (C.A.), Department of Neurology, Massachusetts General Hospital, Boston; and Stroke Research Centre (D.J.W.), University College London Queen Square Institute of Neurology, UK
| | - Steven M Greenberg
- From the Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Hemorrhagic Stroke Research Program (A.C., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School; Stroke Service and Neurovascular Research Lab (C.A.), Department of Neurology, Massachusetts General Hospital, Boston; and Stroke Research Centre (D.J.W.), University College London Queen Square Institute of Neurology, UK
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25
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Banerjee G, Ambler G, Keshavan A, Paterson RW, Foiani MS, Toombs J, Heslegrave A, Dickson JC, Fraioli F, Groves AM, Lunn MP, Fox NC, Zetterberg H, Schott JM, Werring DJ. Cerebrospinal Fluid Biomarkers in Cerebral Amyloid Angiopathy. J Alzheimers Dis 2021; 74:1189-1201. [PMID: 32176643 PMCID: PMC7242825 DOI: 10.3233/jad-191254] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: There is limited data on cerebrospinal fluid (CSF) biomarkers in sporadic amyloid-β (Aβ) cerebral amyloid angiopathy (CAA). Objective: To determine the profile of biomarkers relevant to neurodegenerative disease in the CSF of patients with CAA. Methods: We performed a detailed comparison of CSF markers, comparing patients with CAA, Alzheimer’s disease (AD), and control (CS) participants, recruited from the Biomarkers and Outcomes in CAA (BOCAA) study, and a Specialist Cognitive Disorders Service. Results: We included 10 CAA, 20 AD, and 10 CS participants (mean age 68.6, 62.5, and 62.2 years, respectively). In unadjusted analyses, CAA patients had a distinctive CSF biomarker profile, with significantly lower (p < 0.01) median concentrations of Aβ38, Aβ40, Aβ42, sAβPPα, and sAβPPβ. CAA patients had higher levels of neurofilament light (NFL) than the CS group (p < 0.01), but there were no significant differences in CSF total tau, phospho-tau, soluble TREM2 (sTREM2), or neurogranin concentrations. AD patients had higher total tau, phospho-tau and neurogranin than CS and CAA groups. In age-adjusted analyses, differences for the CAA group remained for Aβ38, Aβ40, Aβ42, and sAβPPβ. Comparing CAA patients with amyloid-PET positive (n = 5) and negative (n = 5) scans, PET positive individuals had lower (p < 0.05) concentrations of CSF Aβ42, and higher total tau, phospho-tau, NFL, and neurogranin concentrations, consistent with an “AD-like” profile. Conclusion: CAA has a characteristic biomarker profile, suggestive of a global, rather than selective, accumulation of amyloid species; we also provide evidence of different phenotypes according to amyloid-PET positivity. Further replication and validation of these preliminary findings in larger cohorts is needed.
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Affiliation(s)
- Gargi Banerjee
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, Gower Street, London, UK
| | - Ashvini Keshavan
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Ross W Paterson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Martha S Foiani
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Jamie Toombs
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Amanda Heslegrave
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - John C Dickson
- Institute of Nuclear Medicine, UCL and University College Hospital, London, UK
| | - Francesco Fraioli
- Institute of Nuclear Medicine, UCL and University College Hospital, London, UK
| | - Ashley M Groves
- Institute of Nuclear Medicine, UCL and University College Hospital, London, UK
| | - Michael P Lunn
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK.,MRC Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK
| | - Nick C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK.,UK Dementia Research Institute at UCL, London, UK.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Salhgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Jonathan M Schott
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
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26
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Disparities in diagnosis of cerebral amyloid angiopathy based on hospital characteristics. J Clin Neurosci 2021; 89:39-42. [PMID: 34119292 DOI: 10.1016/j.jocn.2021.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/04/2021] [Accepted: 04/17/2021] [Indexed: 11/20/2022]
Abstract
Cerebral amyloid angiopathy (CAA) categorized as a cerebral small vessel disease can cause lobar intracerebral hemorrhage (ICH), convexity subarachnoid hemorrhage (SAH) and ischemic stroke (IS). The purpose of this study was to evaluate the differences in the diagnosis of CAA based on hospital characteristics and to assess the discharge outcomes of patients with CAA admitted for IS, ICH and SAH. Adult patients admitted with secondary diagnosis of CAA were identified in National Inpatient Sample in 2016 and 2017. Multivariable logistic regression analysis was performed to evaluate outcomes. A total of 16,040 patients had a secondary diagnosis of CAA. Among CAA patients, 1810 (11.3%) patients were admitted for IS, 4765 (29.7%) for ICH and 490 (3.1%) for SAH. Diagnosis of CAA was five-fold higher among patients admitted to urban teaching hospitals (aOR = 5.4;95% CI = 4.1-7.2) compared to rural hospitals and two-fold higher in large bed size hospitals (aOR = 2.3;95% CI = 2.0-2.7) compared to small bed size hospitals. Compared to non-CAA group, patients with history of CAA had lower odds of in-hospital mortality among patients admitted for ICH (10% vs 23%, aOR = 0.35; 95%CI = 0.27-0.44) and SAH (6% vs 19%, aOR = 0.24; 95%CI = 0.10-0.55); and higher odds of discharge to home among patients admitted for ICH (17% vs 18%, aOR = 1.27; 95%CI = 1.05-1.53). CAA diagnosis is less common in rural and small bed size hospitals compared to urban and large bedside hospitals, respectively. Patients with CAA admitted for ICH have better discharge outcomes compared to non-CAA patients admitted for ICH.
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27
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Vascular Risk Factors, Imaging, and Outcomes in Transient Ischemic Attack/Ischemic Stroke Patients with Neuroimaging Evidence of Probable/Possible Cerebral Amyloid Angiopathy. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:9958851. [PMID: 33995827 PMCID: PMC8096555 DOI: 10.1155/2021/9958851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/11/2021] [Accepted: 04/17/2021] [Indexed: 11/18/2022]
Abstract
Background In TIA/ischemic stroke patients, the clinical significance of lobar microbleeds potentially indicating cerebral amyloid angiopathy (CAA) is unknown. We assessed vascular risk factors and outcomes, including cognition, in TIA/ischemic stroke patients with neuroimaging evidence of probable/possible CAA. Methods This prospective cohort was conducted from August 2015 and January 2018 at 40 centers. 2625 participants were collected. Eligible participants were aged at least 55 years. Montreal Cognitive Assessment (MoCA) score is less than or equal to 26. A total of 1620 patients were included. 1604 (99.0%) and 1582 (97.7%) participants are followed up at 3 and 12 months. The primary outcomes were death or disability (mRS score, 3-6) and Montreal Cognitive Assessment (MoCA) at 3 months and 12 months. Demographic and vascular risk factors were measured at baseline (smoking, alcohol, diabetes, atrial fibrillation, hypertension, hypercholesterolemia, coronary artery disease, ischemic stroke, and transient ischemic attack). Blood samples were collected within 24 hours of admission. MRI was recommended for all patients. MoCA score was evaluated at baseline and follow-up. Results In total, 291/1620 patients with ischemic stroke/TIA (32.7% female and mean age, 67.8 years) had neuroimaging evidence of probable/possible CAA. Higher age, history of hypertension, atrial fibrillation, ischemic stroke, alcohol, and high glucose at the admission were more common in the patients. Mean MoCA changed from 21.4 at 3 months (SD 5.2) to 22.3 at 12 months (SD 4.7), difference 0.3 (SD 3.8). At the 3-month and 12-month follow-up, there were significant differences in age, education level, and sex among different cognitive groups. Higher age, lower education (less than high school), and female sex were the predictors of changing in MoCA score from 3 months to 12 months. Moreover, age (more than 66 years) and education (less than high school) are strongly associated with MoCA at 3- and 12-month follow-up. 30 of 286 (10.5%) and 37 of 281 (13.2%) patients had poor outcome of death or disability (modified Rankin Scale score, 3-6) at follow-up 3 and 12 months. Cortical superficial siderosis (cSS) was associated with higher mRS at follow-up. cSS status, cSS count 1-2, cSS strictly lobar, and strictly deep might be the risks of outcomes in adjusted analyses. Conclusion This study suggested that an increasing number of vascular risk factors and imaging markers were significantly associated with outcomes of TIA/ischemic stroke patients with CAA pattern. Male, young patients with high education should get better cognitive recovery.
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28
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Li X. The association of low-grade albuminuria with incident nonalcoholic fatty liver disease and non-invasive markers of liver fibrosis. Liver Int 2021; 41:220. [PMID: 33034103 DOI: 10.1111/liv.14693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 02/13/2023]
Affiliation(s)
- Xiaofei Li
- Department of infectious diseases, YiWu Central Hospital, Zhejiang, China
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29
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Scheumann V, Schreiber F, Perosa V, Assmann A, Mawrin C, Garz C, Heinze HJ, Görtler M, Düzel E, Vielhaber S, Charidimou A, Schreiber S. MRI phenotyping of underlying cerebral small vessel disease in mixed hemorrhage patients. J Neurol Sci 2020; 419:117173. [PMID: 33068905 DOI: 10.1016/j.jns.2020.117173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate underlying cerebral small vessel disease (CSVD) in patients with mixed cerebral hemorrhages patterns and phenotype them according to the contribution of the two most common sporadic CSVD subtypes: cerebral amyloid angiopathy (CAA) vs. hypertensive arteriopathy (HA). METHODS Brain MRIs of patients with intracerebral hemorrhages (ICHs) and/or cerebral microbleeds (CMBs) were assessed for the full spectrum of CSVD markers using validated scales: ICHs, CMBs, cortical superficial siderosis (cSS), white matter hyperintensities, MRI-visible perivascular spaces (PVS). PVS predominance pattern was grouped as centrum-semiovale (CSO)-PVS predominance, basal-ganglia (BG)-PVS predominance, CSO-PVS and BG-PVS equality. Patients with mixed cerebral hemorrhages were classified into mixed CAA-pattern or mixed HA-pattern according to the existence of cSS and/or a CSO-PVS predominance pattern and comparisons were performed. RESULTS We included 110 patients with CAA (strictly lobar ICHs/CMBs), 33 with HA (strictly deep ICHs/CMBs) and 97 with mixed lobar/deep ICHs/CMBs. Mixed patients were more similar to HA with respect to their MRI-CSVD markers, vascular risk profile and cerebrospinal fluid (CSF) measures. In the mixed patients, 33 (34%) had cSS, a CSO-PVS predominance pattern, or both, and were defined as mixed CAA-pattern cases. The mixed CAA-pattern patients were more alike CAA patients regarding their MRI-CSVD markers, CSF and genetic profile. CONCLUSION Our findings suggest that the heterogeneous group of patients with mixed cerebral hemorrhages distribution can be further phenotyped according to the predominant underlying CSVD. cSS presence and a CSO-PVS predominance pattern could serve as strongly suggestive markers of a contribution from CAA among patients with mixed hemorrhages.
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Affiliation(s)
- Vincent Scheumann
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Frank Schreiber
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE), Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Valentina Perosa
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE), Leipziger Straße 44, 39120 Magdeburg, Germany; J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, 175 Cambridge Street, Boston, MA 02114, USA.
| | - Anne Assmann
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Christian Mawrin
- Institute of Neuropathology, Otto-von-Guericke-University Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Universitätsplatz 2, 39106 Magdeburg, Germany.
| | - Cornelia Garz
- German Center for Neurodegenerative Diseases (DZNE), Leipziger Straße 44, 39120 Magdeburg, Germany; Leibniz Institute for Neurobiology (LIN), Brenneckestraße, 39118 Magdeburg, Germany.
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE), Leipziger Straße 44, 39120 Magdeburg, Germany; Leibniz Institute for Neurobiology (LIN), Brenneckestraße, 39118 Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Universitätsplatz 2, 39106 Magdeburg, Germany.
| | - Michael Görtler
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Emrah Düzel
- German Center for Neurodegenerative Diseases (DZNE), Leipziger Straße 44, 39120 Magdeburg, Germany; Leibniz Institute for Neurobiology (LIN), Brenneckestraße, 39118 Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Universitätsplatz 2, 39106 Magdeburg, Germany; Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE), Leipziger Straße 44, 39120 Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Universitätsplatz 2, 39106 Magdeburg, Germany.
| | - Andreas Charidimou
- Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE), Leipziger Straße 44, 39120 Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Universitätsplatz 2, 39106 Magdeburg, Germany.
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30
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Kang M, Yoon BW. 10-Year Follow-Up of a Patient with Cerebral Amyloid Angiopathy. Case Rep Neurol 2020; 12:202-206. [DOI: 10.1159/000501199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 05/27/2019] [Indexed: 11/19/2022] Open
Abstract
We report the case of long-term follow-up of brain magnetic imaging of cerebral amyloid angiopathy. Cerebral amyloid angiopathy is often considered a major cause of spontaneous intracerebral hemorrhage in the elderly. This case illustrates the markedly progressive clinical and radiological features of the vasculopathic process in 10 years.
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31
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Affiliation(s)
- Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands
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32
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Cisternas P, Taylor X, Perkins A, Maldonado O, Allman E, Cordova R, Marambio Y, Munoz B, Pennington T, Xiang S, Zhang J, Vidal R, Atwood B, Lasagna‐Reeves CA. Vascular amyloid accumulation alters the gabaergic synapse and induces hyperactivity in a model of cerebral amyloid angiopathy. Aging Cell 2020; 19:e13233. [PMID: 32914559 PMCID: PMC7576303 DOI: 10.1111/acel.13233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/08/2020] [Accepted: 07/26/2020] [Indexed: 12/19/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA) is typified by the cerebrovascular deposition of amyloid. The mechanisms underlying the contribution of CAA to neurodegeneration are not currently understood. Although CAA is highly associated with the accumulation of β‐amyloid (Aβ), other amyloids are known to associate with the vasculature. Alzheimer's disease (AD) is characterized by parenchymal Aβ deposition and intracellular accumulation of tau as neurofibrillary tangles (NFTs), affecting synapses directly, leading to behavioral and physical impairment. CAA increases with age and is present in 70%–97% of individuals with AD. Studies have overwhelmingly focused on the connection between parenchymal amyloid accumulation and synaptotoxicity; thus, the contribution of vascular amyloid is mostly understudied. Here, synaptic alterations induced by vascular amyloid accumulation and their behavioral consequences were characterized using a mouse model of Familial Danish dementia (FDD), a neurodegenerative disease characterized by the accumulation of Danish amyloid (ADan) in the vasculature. The mouse model (Tg‐FDD) displays a hyperactive phenotype that potentially arises from impairment in the GABAergic synapses, as determined by electrophysiological analysis. We demonstrated that the disruption of GABAergic synapse organization causes this impairment and provided evidence that GABAergic synapses are impaired in patients with CAA pathology. Understanding the mechanism that CAA contributes to synaptic dysfunction in AD‐related dementias is of critical importance for developing future therapeutic interventions.
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Affiliation(s)
- Pablo Cisternas
- Stark Neurosciences Research Institute Indiana University School of Medicine Indianapolis IN USA
- Department of Anatomy, Cell Biology & Physiology Indiana University School of Medicine Indianapolis IN USA
| | - Xavier Taylor
- Stark Neurosciences Research Institute Indiana University School of Medicine Indianapolis IN USA
- Department of Anatomy, Cell Biology & Physiology Indiana University School of Medicine Indianapolis IN USA
| | - Abigail Perkins
- Stark Neurosciences Research Institute Indiana University School of Medicine Indianapolis IN USA
- Department of Anatomy, Cell Biology & Physiology Indiana University School of Medicine Indianapolis IN USA
| | - Orlando Maldonado
- Stark Neurosciences Research Institute Indiana University School of Medicine Indianapolis IN USA
- Department of Anatomy, Cell Biology & Physiology Indiana University School of Medicine Indianapolis IN USA
| | - Elysabeth Allman
- Stark Neurosciences Research Institute Indiana University School of Medicine Indianapolis IN USA
- Department of Anatomy, Cell Biology & Physiology Indiana University School of Medicine Indianapolis IN USA
| | - Ricardo Cordova
- Stark Neurosciences Research Institute Indiana University School of Medicine Indianapolis IN USA
- Department of Anatomy, Cell Biology & Physiology Indiana University School of Medicine Indianapolis IN USA
| | - Yamil Marambio
- Stark Neurosciences Research Institute Indiana University School of Medicine Indianapolis IN USA
- Department of Anatomy, Cell Biology & Physiology Indiana University School of Medicine Indianapolis IN USA
| | - Braulio Munoz
- Stark Neurosciences Research Institute Indiana University School of Medicine Indianapolis IN USA
- Department of Pharmacology & Toxicology Indiana University School of Medicine Indianapolis IN USA
| | - Taylor Pennington
- Stark Neurosciences Research Institute Indiana University School of Medicine Indianapolis IN USA
- Department of Pharmacology & Toxicology Indiana University School of Medicine Indianapolis IN USA
| | - Shunian Xiang
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis IN USA
| | - Jie Zhang
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis IN USA
| | - Ruben Vidal
- Stark Neurosciences Research Institute Indiana University School of Medicine Indianapolis IN USA
- Department of Pathology and Laboratory Medicine Indiana University School of Medicine Indianapolis IN USA
| | - Brady Atwood
- Stark Neurosciences Research Institute Indiana University School of Medicine Indianapolis IN USA
- Department of Pharmacology & Toxicology Indiana University School of Medicine Indianapolis IN USA
| | - Cristian A. Lasagna‐Reeves
- Stark Neurosciences Research Institute Indiana University School of Medicine Indianapolis IN USA
- Department of Anatomy, Cell Biology & Physiology Indiana University School of Medicine Indianapolis IN USA
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33
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Biessels GJ, Nobili F, Teunissen CE, Simó R, Scheltens P. Understanding multifactorial brain changes in type 2 diabetes: a biomarker perspective. Lancet Neurol 2020; 19:699-710. [PMID: 32445622 DOI: 10.1016/s1474-4422(20)30139-3] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/20/2020] [Accepted: 04/08/2020] [Indexed: 12/14/2022]
Abstract
People with type 2 diabetes are at an increased risk of cognitive impairment and dementia (including Alzheimer's disease), as well as subtle forms of cognitive dysfunction. Current diabetes guidelines recommend screening for cognitive impairment in groups at high risk and providing guidance for diabetes management in patients with diabetes and cognitive impairment. Yet, no disease-modifying treatment is available and important questions remain about the mechanisms underlying diabetes-associated cognitive dysfunction. These mechanisms are likely to be multifactorial and different for subtle and more severe forms of diabetes-associated cognitive dysfunction. Over the past years, research on dementia, brain ageing, diabetes, and vascular disease has identified novel biomarkers of specific dementia aetiologies, brain parenchymal injury, and cerebral blood flow and metabolism. These markers shed light on the processes underlying diabetes-associated cognitive dysfunction, have clear applications in current research and increasingly in clinical diagnosis, and might ultimately guide targeted treatment.
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Affiliation(s)
- Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Flavio Nobili
- Department of Neuroscience, Ophthalmology, Genetics, and Child and Mother Health, University of Genoa, Genoa, Italy; Clinical Neurology Unit, IRCSS Ospedale Policlinico San Martino, Genoa, Italy
| | - Charlotte E Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam, Netherlands
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Philip Scheltens
- Department of Neurology and Alzheimer Center, VU University Medical Center Amsterdam, Amsterdam, Netherlands
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34
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Feasibility of clinical trial recruitment for cerebral amyloid angiopathy: A specialist single centre experience. J Neurol Sci 2020; 409:116580. [DOI: 10.1016/j.jns.2019.116580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/24/2019] [Accepted: 11/13/2019] [Indexed: 01/20/2023]
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35
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Greenberg SM, Bacskai BJ, Hernandez-Guillamon M, Pruzin J, Sperling R, van Veluw SJ. Cerebral amyloid angiopathy and Alzheimer disease - one peptide, two pathways. Nat Rev Neurol 2020; 16:30-42. [PMID: 31827267 PMCID: PMC7268202 DOI: 10.1038/s41582-019-0281-2] [Citation(s) in RCA: 421] [Impact Index Per Article: 105.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2019] [Indexed: 12/22/2022]
Abstract
The shared role of amyloid-β (Aβ) deposition in cerebral amyloid angiopathy (CAA) and Alzheimer disease (AD) is arguably the clearest instance of crosstalk between neurodegenerative and cerebrovascular processes. The pathogenic pathways of CAA and AD intersect at the levels of Aβ generation, its circulation within the interstitial fluid and perivascular drainage pathways and its brain clearance, but diverge in their mechanisms of brain injury and disease presentation. Here, we review the evidence for and the pathogenic implications of interactions between CAA and AD. Both pathologies seem to be driven by impaired Aβ clearance, creating conditions for a self-reinforcing cycle of increased vascular Aβ, reduced perivascular clearance and further CAA and AD progression. Despite the close relationship between vascular and plaque Aβ deposition, several factors favour one or the other, such as the carboxy-terminal site of the peptide and specific co-deposited proteins. Amyloid-related imaging abnormalities that have been seen in trials of anti-Aβ immunotherapy are another probable intersection between CAA and AD, representing overload of perivascular clearance pathways and the effects of removing Aβ from CAA-positive vessels. The intersections between CAA and AD point to a crucial role for improving vascular function in the treatment of both diseases and indicate the next steps necessary for identifying therapies.
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Affiliation(s)
- Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Brian J Bacskai
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mar Hernandez-Guillamon
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jeremy Pruzin
- Center for Alzheimer Research and Treatment, Brigham & Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Reisa Sperling
- Center for Alzheimer Research and Treatment, Brigham & Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Susanne J van Veluw
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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36
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Smith EE, Wollenweber FA. Cerebellar Microbleed Patterns: Potential Relevance for the Boston Criteria, Version 2.0. Stroke 2019; 51:4-5. [PMID: 31726964 DOI: 10.1161/strokeaha.119.027416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eric E Smith
- From the Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.)
| | - Frank A Wollenweber
- Institute for Stroke and Dementia Research (F.A.W.), Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
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37
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Charidimou A, Boulouis G, Greenberg SM, Viswanathan A. Cortical superficial siderosis and bleeding risk in cerebral amyloid angiopathy: A meta-analysis. Neurology 2019; 93:e2192-e2202. [PMID: 31732564 DOI: 10.1212/wnl.0000000000008590] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/17/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the association of cortical superficial siderosis (cSS) presence and extent with future bleeding risk in cerebral amyloid angiopathy (CAA). METHODS This was a meta-analysis of clinical cohorts of symptomatic patients with CAA who had T2*-MRI at baseline and clinical follow-up for future intracerebral hemorrhage (ICH). We pooled data in a 2-stage meta-analysis using random effects models. Covariate-adjusted hazard ratios (adjHR) from multivariable Cox proportional hazard models were used. RESULTS We included data from 6 eligible studies (n = 1,239). cSS pooled prevalence was 34% (95% confidence interval [CI] 26%-41%; I 2 87.94%; p < 0.001): focal cSS prevalence was 14% (95% CI 12%-16%; I 2 6.75%; p = 0.37), and disseminated cSS prevalence was 20% (95% CI 13%-26%; I 2 90.39%; p < 0.001). During a mean follow-up of 3.1 years (range 1-4 years), 162/1,239 patients experienced a symptomatic ICH-pooled incidence rate 6.9% per year (95% CI 3.9%-9.8% per year; I 2 83%; p < 0.001). ICH incidence rates per year according to cSS status were 3.9% (95% CI 1.7%-6.1%; I 2 70%; p = 0.018) for patients without cSS, 11.1% (95% CI 7%-15.2%; I 2 56.8%; p = 0.074) for cSS presence, 9.1% (95% CI 5.5%-12.8%; I 2 0%; p = 0.994) for focal cSS, and 12.5% (95% CI 5.3%-19.7%; I 2 73.2%; p = 0.011) for disseminated cSS. In adjusted pooled analysis, any cSS presence was independently associated with increased future ICH risk (adjHR 2.14; 95% CI 1.19-3.85; p < 0.0001). Focal cSS was linked with ICH risk (adjHR 2.11; 95% CI 1.31-2.41; p = 0.002), while disseminated cSS conferred the strongest bleeding risk (adjHR 4.28; 95% CI 2.91-6.30; p < 0.0001). CONCLUSION In patients with CAA, cSS presence and extent are the most important MRI prognostic risk factors for future ICH, likely useful in treatment planning. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that in symptomatic CAA survivors with baseline T2*-MRI, cSS (particularly if disseminated, i.e., affecting >3 sulci) increases the risk of future ICH.
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Affiliation(s)
- Andreas Charidimou
- From the Hemorrhagic Stroke Research Program (A.C., G.B., S.M.G., A.V.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; and Department of Neuroradiology (G.B.), Centre Hospitalier Sainte-Anne, Université Paris-Descartes, France.
| | - Gregoire Boulouis
- From the Hemorrhagic Stroke Research Program (A.C., G.B., S.M.G., A.V.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; and Department of Neuroradiology (G.B.), Centre Hospitalier Sainte-Anne, Université Paris-Descartes, France
| | - Steven M Greenberg
- From the Hemorrhagic Stroke Research Program (A.C., G.B., S.M.G., A.V.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; and Department of Neuroradiology (G.B.), Centre Hospitalier Sainte-Anne, Université Paris-Descartes, France
| | - Anand Viswanathan
- From the Hemorrhagic Stroke Research Program (A.C., G.B., S.M.G., A.V.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; and Department of Neuroradiology (G.B.), Centre Hospitalier Sainte-Anne, Université Paris-Descartes, France
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Charidimou A. Cerebral amyloid angiopathy-related transient focal neurological episodes (CAA-TFNEs): A well-defined clinical-radiological syndrome. J Neurol Sci 2019; 406:116496. [DOI: 10.1016/j.jns.2019.116496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022]
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Hachinski V, Einhäupl K, Ganten D, Alladi S, Brayne C, Stephan BCM, Sweeney MD, Zlokovic B, Iturria-Medina Y, Iadecola C, Nishimura N, Schaffer CB, Whitehead SN, Black SE, Østergaard L, Wardlaw J, Greenberg S, Friberg L, Norrving B, Rowe B, Joanette Y, Hacke W, Kuller L, Dichgans M, Endres M, Khachaturian ZS. Special topic section: linkages among cerebrovascular, cardiovascular, and cognitive disorders: Preventing dementia by preventing stroke: The Berlin Manifesto. Int J Stroke 2019:1747493019871915. [PMID: 31543058 DOI: 10.1177/1747493019871915] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
The incidence of stroke and dementia are diverging across the world, rising for those in low-and middle-income countries and falling in those in high-income countries. This suggests that whatever factors cause these trends are potentially modifiable. At the population level, neurological disorders as a group account for the largest proportion of disability-adjusted life years globally (10%). Among neurological disorders, stroke (42%) and dementia (10%) dominate. Stroke and dementia confer risks for each other and share some of the same, largely modifiable, risk and protective factors. In principle, 90% of strokes and 35% of dementias have been estimated to be preventable. Because a stroke doubles the chance of developing dementia and stroke is more common than dementia, more than a third of dementias could be prevented by preventing stroke. Developments at the pathological, pathophysiological, and clinical level also point to new directions. Growing understanding of brain pathophysiology has unveiled the reciprocal interaction of cerebrovascular disease and neurodegeneration identifying new therapeutic targets to include protection of the endothelium, the blood-brain barrier, and other components of the neurovascular unit. In addition, targeting amyloid angiopathy aspects of inflammation and genetic manipulation hold new testable promise. In the meantime, accumulating evidence suggests that whole populations experiencing improved education, and lower vascular risk factor profiles (e.g., reduced prevalence of smoking) and vascular disease, including stroke, have better cognitive function and lower dementia rates. At the individual levels, trials have demonstrated that anticoagulation of atrial fibrillation can reduce the risk of dementia by 48% and that systolic blood pressure lower than 140 mmHg may be better for the brain. Based on these considerations, the World Stroke Organization has issued a proclamation, endorsed by all the major international organizations focused on global brain and cardiovascular health, calling for the joint prevention of stroke and dementia. This article summarizes the evidence for translation into action. © 2019 the Alzheimer's Association and the World Stroke Organisation. Published by Elsevier Inc. All rights reserved.
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Affiliation(s)
- Vladimir Hachinski
- Department of Clinical Neurological Sciences, Western University, Ontario, Canada
| | - Karl Einhäupl
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Detlev Ganten
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Carol Brayne
- Department of Public Health and Primary Care in the University of Cambridge, Cambridge, UK
| | - Blossom C M Stephan
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Melanie D Sweeney
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Berislav Zlokovic
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yasser Iturria-Medina
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Nozomi Nishimura
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Chris B Schaffer
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Shawn N Whitehead
- Department of Anatomy and Cell Biology, Western University, Ontario, Canada
| | - Sandra E Black
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Leif Østergaard
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, Edinburgh Imaging, UK Dementia Research Institute, University of Edinburgh, Scotland, UK
| | - Steven Greenberg
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Leif Friberg
- Department of Clinical Sciences, Karolinska Institute, Stockholm, Sweden
| | - Bo Norrving
- Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden
| | - Brian Rowe
- Department of Emergency Medicine and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Yves Joanette
- Canadian Institute of Health and Research, Ottawa, Canada
| | - Werner Hacke
- Department of Neurology, Heidelberg University, Heidelberg, Germany
| | - Lewis Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-Universität LMU, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany
| | - Matthias Endres
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- ExcellenceCluster NeuroCure, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), partner site Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
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Charidimou A, Frosch MP, Al-Shahi Salman R, Baron JC, Cordonnier C, Hernandez-Guillamon M, Linn J, Raposo N, Rodrigues M, Romero JR, Schneider JA, Schreiber S, Smith EE, van Buchem MA, Viswanathan A, Wollenweber FA, Werring DJ, Greenberg SM. Advancing diagnostic criteria for sporadic cerebral amyloid angiopathy: Study protocol for a multicenter MRI-pathology validation of Boston criteria v2.0. Int J Stroke 2019; 14:956-971. [PMID: 31514686 DOI: 10.1177/1747493019855888] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
RATIONALE The Boston criteria are used worldwide for the in vivo diagnosis of cerebral amyloid angiopathy and are the basis for clinical decision-making and research in the field. Given substantial advances in cerebral amyloid angiopathy's clinical aspects and MRI biomarkers, we designed a multicenter study within the International cerebral amyloid angiopathy Association aimed at further validating the diagnostic accuracy of the Boston and potentially improving and updating them. AIM We aim to derive and validate an updated "version 2.0" of the Boston criteria across the spectrum of cerebral amyloid angiopathy-related presentations and MRI biomarkers. SAMPLE SIZE ESTIMATES Participating centers with suitable available data (see Methods) were identified from existing collaborations and an open invitation to the International Cerebral Amyloid Angiopathy Association emailing list. Our study sample will include: (1) a derivation cohort - Massachusetts General Hospital (MGH), Boston cases from inception to 2012 (∼150 patients); (2) temporal external validation cohort - MGH, Boston cases from 2012 to 2018 (∼100 patients); and (3) geographical external validation cohort - non-Boston cases (∼85 patients). METHODS AND DESIGN Multicenter collaborative study. We will collect and analyze data from patients' age ≥ 50 with any potential sporadic cerebral amyloid angiopathy-related clinical presentations (spontaneous intracerebral hemorrhage, transient focal neurological episodes and cognitive impairment), available brain MRI ("index test"), and histopathologic assessment for cerebral amyloid angiopathy ("reference standard" for diagnosis). Trained raters will assess MRI for all prespecified hemorrhagic and non-hemorrhagic small vessel disease markers of interest, according to validated criteria and a prespecified protocol, masked to clinical and histopathologic features. Brain tissue samples will be rated for cerebral amyloid angiopathy, defined as Vonsattel grade ≥2 for whole brain autopsies and ≥1 for cortical biopsies or hematoma evacuation. Based on our estimated available sample size, we will undertake pre-specified cohort splitting as above. We will: (a) pre-specify variables and statistical cut-offs; (b) examine univariable and multivariable associations; and (c) then assess classification measures (sensitivity, specificity etc.) for each MRI biomarker individually, in relation to the cerebral amyloid angiopathy diagnosis reference standard on neuropathology in a derivation cohort. The MRI biomarkers strongly associated with cerebral amyloid angiopathy diagnosis will be selected for inclusion in provisional (probable and possible cerebral amyloid angiopathy) Boston criteria v2.0 and validated using appropriate metrics and models. STUDY OUTCOMES Boston criteria v2.0 for clinical cerebral amyloid angiopathy diagnosis. DISCUSSION This work aims to potentially update and improve the diagnostic test accuracy of the Boston criteria for cerebral amyloid angiopathy and to provide wider validation of the criteria in a large sample. We envision that this work will meet the needs of clinicians and investigators and help accelerate progress towards better treatment of cerebral amyloid angiopathy.
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Affiliation(s)
- Andreas Charidimou
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew P Frosch
- C.S. Kubik Laboratory of Neuropathology, Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Jean-Claude Baron
- Department of Neurology, Sainte-Anne Hospital, Université Paris Descartes, INSERM U894, Paris, France
| | - Charlotte Cordonnier
- Department of Neurology, INSERM U1171-Degenerative and Vascular Cognitive Disorders, CHU Lille, University of Lille, Lille, France
| | - Mar Hernandez-Guillamon
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jennifer Linn
- Department of Neuroradiology, University Hospital Carl Gustav Carus', Technische Universität Dresden, Dresden, SN, Germany
| | - Nicolas Raposo
- Department of Neurology, Toulouse University Medical Center, Toulouse, France
| | - Mark Rodrigues
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jose Rafael Romero
- Department of Neurology, Boston University School of Medicine, MA and the Framingham Heart Study, MA, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | | | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Frank A Wollenweber
- Institute for Stroke and Dementia Research, Ludwig Maximilians University, Munich, Germany
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Steven M Greenberg
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Schreiber S, Wilisch-Neumann A, Schreiber F, Assmann A, Scheumann V, Perosa V, Jandke S, Mawrin C, Carare RO, Werring DJ. Invited Review: The spectrum of age-related small vessel diseases: potential overlap and interactions of amyloid and nonamyloid vasculopathies. Neuropathol Appl Neurobiol 2019; 46:219-239. [PMID: 31386773 DOI: 10.1111/nan.12576] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 12/12/2022]
Abstract
Deep perforator arteriopathy (DPA) and cerebral amyloid angiopathy (CAA) are the commonest known cerebral small vessel diseases (CSVD), which cause ischaemic stroke, intracebral haemorrhage (ICH) and vascular cognitive impairment (VCI). While thus far mainly considered as separate entities, we here propose that DPA and CAA share similarities, overlap and interact, so that 'pure' DPA or CAA are extremes along a continuum of age-related small vessel pathologies. We suggest blood-brain barrier (BBB) breakdown, endothelial damage and impaired perivascular β-amyloid (Aβ) drainage are hallmark common mechanisms connecting DPA and CAA. We also suggest a need for new biomarkers (e.g. high-resolution imaging) to deepen understanding of the complex relationships between DPA and CAA.
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Affiliation(s)
- S Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany.,Center for behavioral brain sciences (CBBS), Magdeburg, Germany
| | - A Wilisch-Neumann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - F Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - A Assmann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - V Scheumann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - V Perosa
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - S Jandke
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - C Mawrin
- Department of Neuropathology, Otto-von-Guericke University, Magdeburg, Germany
| | - R O Carare
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - D J Werring
- Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
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Kaiser J, Schebesch KM, Brawanski A, Linker RA, Schlachetzki F, Wagner A. Long-Term Follow-Up of Cerebral Amyloid Angiopathy-Associated Intracranial Hemorrhage Reveals a High Prevalence of Atrial Fibrillation. J Stroke Cerebrovasc Dis 2019; 28:104342. [PMID: 31521517 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104342] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/17/2019] [Accepted: 08/06/2019] [Indexed: 12/13/2022] Open
Abstract
GOAL Cerebral amyloid angiopathy (CAA) is the second-most common cause of nontraumatic intracerebral hemorrhages (ICH), surpassed only by uncontrolled hypertension. We characterized the percentage, risk factors, and comorbidities of patients suffering from CAA-related ICH in relation to long-term outcomes. MATERIAL AND METHODS We performed retrospective analyses and clinical follow-ups of individuals suffering from ICH who were directly admitted to neurosurgery between 2002 and 2016. FINDINGS Seventy-four of 174 (42%) spontaneous nontraumatic lobar ICH cases leastwise satisfied the modified Boston criteria definition for at least "possible CAA." Females suffered a higher risk of CAA-caused ICH (42 of 74, 56.8%, P= .035). Atrial fibrillation as a major comorbidity was observed in 19 patients (25.7%). Recovery (decrease of modified Rankin scale [mRS]) was highest during hospitalization in the acute clinic. One-year mortality was as follows: 14 of 25 patients (56%) with probable CAA without supporting pathology, 6 of 18, and 8 of 31 patients with supporting pathology and possible CAA, respectively. Only 10 of 74 (13.6%) had favorable long-term outcomes (mRS ≤2). Increasing numbers of lobar hemorrhages, low initial Glasgow Coma Scale, and subarachnoid hemorrhage were significantly associated with poor survivability, whereas statins, antithrombotic agents, an intraventricular hemorrhage, and midline shift played seemingly minor roles. CONCLUSIONS Symptomatic ICH is a serious stage in CAA progression with high mortality. The high incidence of concurrent atrial fibrillation in these patients may support data on more widespread vascular pathology in CAA.
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Affiliation(s)
- Johanna Kaiser
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | | | - Alexander Brawanski
- Department of Neurosurgery, University Clinic Regensburg, Regensburg, Germany
| | - Ralf A Linker
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | | | - Andrea Wagner
- Department of Neurology, University of Regensburg, Regensburg, Germany.
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Carmona-Iragui M, Videla L, Lleó A, Fortea J. Down syndrome, Alzheimer disease, and cerebral amyloid angiopathy: The complex triangle of brain amyloidosis. Dev Neurobiol 2019; 79:716-737. [PMID: 31278851 DOI: 10.1002/dneu.22709] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 05/04/2019] [Accepted: 07/02/2019] [Indexed: 11/07/2022]
Abstract
Down syndrome (DS) is the main genetic cause of intellectual disability worldwide. The overexpression of the Amyloid Precursor Protein, present in chromosome 21, leads to β-amyloid deposition that results in Alzheimer disease (AD) and, in most cases, also to cerebral amyloid angiopathy (CAA) neuropathology. People with DS invariably develop the neuropathological hallmarks of AD at the age of 40, and they are at an ultra high risk for suffering AD-related cognitive impairment thereafter. In the general population, cerebrovascular disease is a significant contributor to AD-related cognitive impairment, while in DS remains understudied. This review describes the current knowledge on cerebrovascular disease in DS and reviews the potential biomarkers that could be useful in the future studies, focusing on CAA. We also discuss available evidence on sporadic AD or other genetically determined forms of AD. We highlight the urgent need of large biomarker-characterized cohorts, including neuropathological correlations, to study the exact contribution of CAA and related vascular factors that play a role in cognition and occur with aging, their characterization and interrelationships. DS represents a unique context in which to perform these studies as this population is relatively protected from some conventional vascular risk factors and they develop significant CAA, DS represents a particular atheroma-free model to study AD-related vascular pathologies. Only deepening on these underlying mechanisms, new preventive and therapeutic strategies could be designed to improve the quality of life of this population and their caregivers and lead to new avenues of treatment also in the general AD population.
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Affiliation(s)
- María Carmona-Iragui
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau- Biomedical Research Institute Sant Pau- Universitat Autònoma de Barcelona, Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Laura Videla
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau- Biomedical Research Institute Sant Pau- Universitat Autònoma de Barcelona, Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Alberto Lleó
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau- Biomedical Research Institute Sant Pau- Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Juan Fortea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau- Biomedical Research Institute Sant Pau- Universitat Autònoma de Barcelona, Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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Sakai K, Ueda M, Fukushima W, Tamaoka A, Shoji M, Ando Y, Yamada M. Nationwide survey on cerebral amyloid angiopathy in Japan. Eur J Neurol 2019; 26:1487-1493. [PMID: 31232495 DOI: 10.1111/ene.14031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 06/18/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE A nationwide survey was conducted to understand the epidemiology of cerebral amyloid angiopathy-related intracerebral hemorrhage (CAA-related ICH) and cerebral amyloid angiopathy-related inflammation/vasculitis (CAA-ri) in Japan. METHODS To estimate the total number and clinical features of patients with CAA-related ICH and CAA-ri between January 2012 and December 2014 and to analyze their clinical features, questionnaires were sent to randomly selected hospitals in Japan. RESULTS In the first survey, 2348 of 4657 departments responded to the questionnaire (response rate 50.4%). The total numbers of reported patients with CAA-related ICH and CAA-ri were 1338 and 61, respectively, and their total numbers in Japan were estimated to be 5900 [95% confidence interval (CI) 4800-7100] and 170 (95% CI 110-220), respectively. The crude prevalence rates were 4.64 and 0.13 per 100 000 population, respectively. The clinical information of 474 patients with CAA-related ICH obtained in the second survey was as follows: (i) the average age of onset was 78.4 years; (ii) the prevalence increased with age; (iii) the disease was common in women; and (iv) hematoma most frequently occurred in the frontal lobe. Sixteen patients with CAA-ri for whom data were collected in the second survey had the following characteristics: (i) median age of onset was 75 years; (ii) cognitive impairment and headache were the most frequent initial manifestations; and (iii) focal neurological signs, such as motor paresis and visual disturbance, were frequently observed during the clinical course. CONCLUSIONS The numbers of patients with CAA-related ICH and CAA-ri in Japan were estimated.
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Affiliation(s)
- K Sakai
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - M Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - W Fukushima
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - A Tamaoka
- Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - M Shoji
- Department of Neurology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Y Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - M Yamada
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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Hachinski V, Einhäupl K, Ganten D, Alladi S, Brayne C, Stephan BCM, Sweeney MD, Zlokovic B, Iturria-Medina Y, Iadecola C, Nishimura N, Schaffer CB, Whitehead SN, Black SE, Østergaard L, Wardlaw J, Greenberg S, Friberg L, Norrving B, Rowe B, Joanette Y, Hacke W, Kuller L, Dichgans M, Endres M, Khachaturian ZS. Preventing dementia by preventing stroke: The Berlin Manifesto. Alzheimers Dement 2019; 15:961-984. [PMID: 31327392 PMCID: PMC7001744 DOI: 10.1016/j.jalz.2019.06.001] [Citation(s) in RCA: 195] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The incidence of stroke and dementia are diverging across the world, rising for those in low- and middle-income countries and falling in those in high-income countries. This suggests that whatever factors cause these trends are potentially modifiable. At the population level, neurological disorders as a group account for the largest proportion of disability-adjusted life years globally (10%). Among neurological disorders, stroke (42%) and dementia (10%) dominate. Stroke and dementia confer risks for each other and share some of the same, largely modifiable, risk and protective factors. In principle, 90% of strokes and 35% of dementias have been estimated to be preventable. Because a stroke doubles the chance of developing dementia and stroke is more common than dementia, more than a third of dementias could be prevented by preventing stroke. Developments at the pathological, pathophysiological, and clinical level also point to new directions. Growing understanding of brain pathophysiology has unveiled the reciprocal interaction of cerebrovascular disease and neurodegeneration identifying new therapeutic targets to include protection of the endothelium, the blood-brain barrier, and other components of the neurovascular unit. In addition, targeting amyloid angiopathy aspects of inflammation and genetic manipulation hold new testable promise. In the meantime, accumulating evidence suggests that whole populations experiencing improved education, and lower vascular risk factor profiles (e.g., reduced prevalence of smoking) and vascular disease, including stroke, have better cognitive function and lower dementia rates. At the individual levels, trials have demonstrated that anticoagulation of atrial fibrillation can reduce the risk of dementia by 48% and that systolic blood pressure lower than 140 mmHg may be better for the brain. Based on these considerations, the World Stroke Organization has issued a proclamation, endorsed by all the major international organizations focused on global brain and cardiovascular health, calling for the joint prevention of stroke and dementia. This article summarizes the evidence for translation into action.
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Affiliation(s)
- Vladimir Hachinski
- Department of Clinical Neurological Sciences, Western University, Ontario, Canada.
| | - Karl Einhäupl
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Detlev Ganten
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Carol Brayne
- Department of Public Health and Primary Care in the University of Cambridge, Cambridge, UK
| | - Blossom C M Stephan
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Melanie D Sweeney
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Berislav Zlokovic
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yasser Iturria-Medina
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Nozomi Nishimura
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Chris B Schaffer
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Shawn N Whitehead
- Department of Anatomy and Cell Biology, Western University, Ontario, Canada
| | - Sandra E Black
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Leif Østergaard
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark; Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, Edinburgh Imaging, UK Dementia Research Institute, University of Edinburgh, Scotland, UK
| | - Steven Greenberg
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Leif Friberg
- Department of Clinical Sciences, Karolinska Institute, Stockholm, Sweden
| | - Bo Norrving
- Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden
| | - Brian Rowe
- Department of Emergency Medicine and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Yves Joanette
- Canadian Institute of Health and Research, Ottawa, Canada
| | - Werner Hacke
- Department of Neurology, Heidelberg University, Heidelberg, Germany
| | - Lewis Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-Universität LMU, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany
| | - Matthias Endres
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany; ExcellenceCluster NeuroCure, Charité-Universitätsmedizin Berlin, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE), partner site Berlin, Berlin, Germany; German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
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Charidimou A, Zonneveld HI, Shams S, Kantarci K, Shoamanesh A, Hilal S, Yates PA, Boulouis G, Na HK, Pasi M, Biffi A, Chai YL, Chong JR, Wahlund LO, Clifford JR, Chen C, Gurol ME, Goldstein JN, Na DL, Barkhof F, Seo SW, Rosand J, Greenberg SM, Viswanathan A. APOE and cortical superficial siderosis in CAA: Meta-analysis and potential mechanisms. Neurology 2019; 93:e358-e371. [PMID: 31243071 DOI: 10.1212/wnl.0000000000007818] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 03/11/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To assess potential mechanisms of cortical superficial siderosis (cSS), a central MRI biomarker in cerebral amyloid angiopathy (CAA), we performed a collaborative meta-analysis of APOE associations with cSS presence and severity. METHODS We pooled data from published studies reporting APOE genotype and MRI assessment of cSS in 3 distinct settings: (1) stroke clinic patients with symptomatic CAA (i.e., lobar intracerebral hemorrhage, transient focal neurologic episodes) according to the Boston criteria; (2) memory clinic patients; and (3) population-based studies. We compared cSS presence and severity (focal or disseminated vs no cSS) in participants with ε2+ or ε4+ genotype vs the ε3/ε3 genotype, by calculating study-specific and random effects pooled, unadjusted odds ratios (ORs). RESULTS Thirteen studies fulfilled inclusion criteria: 7 memory clinic cohorts (n = 2,587), 5 symptomatic CAA cohorts (n = 402), and 1 population-based study (n = 1,379). There was no significant overall association between APOE ε4+ and cSS presence or severity. When stratified by clinical setting, APOE ε4+ was associated with cSS in memory clinic (OR 2.10; 95% confidence interval [CI] 1.11-3.99) but not symptomatic CAA patients. The pooled OR showed significantly increased odds of having cSS for APOE ε2+ genotypes (OR 2.42, 95% CI 1.48-3.95) in both patient populations. This association was stronger for disseminated cSS in symptomatic CAA cohorts. In detailed subgroup analyses, APOE ε2/ε2 and APOE ε2/ε4 genotypes were most consistently and strongly associated with cSS presence and severity. CONCLUSION CAA-related vasculopathic changes and fragility associated with APOE ε2+ allele might have a biologically meaningful role in the pathophysiology and severity of cSS.
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Affiliation(s)
- Andreas Charidimou
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.
| | - Hazel I Zonneveld
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sara Shams
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Kejal Kantarci
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ashkan Shoamanesh
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Saima Hilal
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Paul A Yates
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Gregoire Boulouis
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Han Kyu Na
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Marco Pasi
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Allesandro Biffi
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Yuek Ling Chai
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Joyce Ruifen Chong
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Lars-Olof Wahlund
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jack R Clifford
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Christopher Chen
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - M Edip Gurol
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Joshua N Goldstein
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Duk L Na
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Frederik Barkhof
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sang Won Seo
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jonathan Rosand
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Steven M Greenberg
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Anand Viswanathan
- From the Hemorrhagic Stroke Research Program, Department of Neurology (A.C., M.P., A.B., M.E.G., J.N.G., J.R., S.M.G., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Alzheimer Center and the Neuroscience Campus Amsterdam and Departments of Radiology and Nuclear Medicine (H.I.Z., F.B.), VU University Medical Center, the Netherlands; Karolinska Institutet (S.S., L.-O.W.), Karolinska University Hospital, Stockholm, Sweden; Department of Radiology (K.K., J.R.C.), Mayo Clinic, Rochester, MN; Department of Medicine (Neurology) (A.S.), McMaster University and Population Health Research Institute, Hamilton, Canada; Memory, Aging and Cognition Center (S.H., Y.L.C., J.R.C., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., Y.L.C., J.R.C., C.C.), National University of Singapore; Department of Nuclear Medicine and Centre for PET (P.A.Y.), The University of Melbourne, Parkville, Australia; Department of Neuroradiology (G.B.), Université Paris-Descartes, INSERM U894, CH Sainte-Anne, Paris, France; Department of Neurology and Neuroscience Center (H.K.N., D.L.N., S.W.S.), Samsung Medical Center, Seoul, Republic of Korea; UCL Institutes of Neurology and Healthcare Engineering (F.B.), London, UK; and Center for Genomic Medicine (J.R.) and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
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Chen SJ, Tsai HH, Tsai LK, Tang SC, Lee BC, Liu HM, Yen RF, Jeng JS. Advances in cerebral amyloid angiopathy imaging. Ther Adv Neurol Disord 2019; 12:1756286419844113. [PMID: 31105769 PMCID: PMC6501479 DOI: 10.1177/1756286419844113] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/25/2019] [Indexed: 11/16/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA) is a cerebral small vessel disease caused by β -amyloid (Aβ) deposition at the leptomeningeal vessel walls. It is a common cause of spontaneous intracerebral hemorrhage and a frequent comorbidity in Alzheimer’s disease. The high recurrent hemorrhage rate in CAA makes it very important to recognize this disease to avoid potential harmful medication. Imaging studies play an important role in diagnosis and research of CAA. Conventional computed tomography and magnetic resonance imaging (MRI) methods reveal anatomical alterations, and remains as the most reliable tool in identifying CAA according to modified Boston criteria. The vascular injuries of CAA result in both hemorrhagic and ischemic manifestations and related structural changes on MRI, including cerebral microbleeds, cortical superficial siderosis, white matter hyperintensity, MRI-visible perivascular spaces, and cortical microinfarcts. As imaging techniques advance, not only does the resolution of conventional imaging improve, but novel skills in functional and molecular imaging studies also enable in vivo analysis of vessel physiological changes and underlying pathology. These modern tools help in early detection of CAA and may potentially serve as sensitive outcome markers in future clinical trials. In this article, we reviewed past studies of CAA focusing on utilization of various conventional and novel imaging techniques in both research and clinical aspects.
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Affiliation(s)
- Szu-Ju Chen
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital Bei-Hu Branch, No. 87, Neijiang Street, Taipei, 10845, Taiwan
| | - Li-Kai Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sung-Chun Tang
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Bo-Chin Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Hon-Man Liu
- Department of Medical Imaging, Fu-Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
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Novel Therapeutic Potentials of Taxifolin for Amyloid-β-associated Neurodegenerative Diseases and Other Diseases: Recent Advances and Future Perspectives. Int J Mol Sci 2019; 20:ijms20092139. [PMID: 31052203 PMCID: PMC6539020 DOI: 10.3390/ijms20092139] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 04/17/2019] [Accepted: 04/27/2019] [Indexed: 12/21/2022] Open
Abstract
Amyloid-β (Aβ) has been closely implicated in the pathogenesis of cerebral amyloid angiopathy (CAA) and Alzheimer’s disease (AD), the major causes of dementia. Thus, Aβ could be a target for the treatment of these diseases, for which, currently, there are no established effective treatments. Taxifolin is a bioactive catechol-type flavonoid present in various plants, such as herbs, and it exhibits pleiotropic effects including anti-oxidant and anti-glycation activities. Recently, we have demonstrated that taxifolin inhibits Aβ fibril formation in vitro and have further shown that it improves cerebral blood flow, facilitating Aβ clearance in the brain and suppressing cognitive decline in a mouse model of CAA. These findings suggest the novel therapeutic potentials of taxifolin for CAA. Furthermore, recent extensive studies have reported several novel aspects of taxifolin supporting its potential as a therapeutic drug for AD and metabolic diseases with a high risk for dementia as well as for CAA. In this review, we have summarized the recent advances in taxifolin research based on in vitro, in vivo, and in silico approaches. Furthermore, we have discussed future research directions on the potential of taxifolin for use in novel therapeutic strategies for CAA, AD, and metabolic diseases with an increased risk for dementia.
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van Veluw SJ, Reijmer YD, van der Kouwe AJ, Charidimou A, Riley GA, Leemans A, Bacskai BJ, Frosch MP, Viswanathan A, Greenberg SM. Histopathology of diffusion imaging abnormalities in cerebral amyloid angiopathy. Neurology 2019; 92:e933-e943. [PMID: 30700595 PMCID: PMC6404469 DOI: 10.1212/wnl.0000000000007005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/23/2018] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE We sought to determine the underlying mechanism for altered white matter diffusion tensor imaging (DTI) measures at the histopathologic level in patients with cerebral amyloid angiopathy (CAA). METHODS Formalin-fixed intact hemispheres from 9 CAA cases and 2 elderly controls were scanned at 3-tesla MRI, including a diffusion-weighted sequence. DTI measures (i.e., fractional anisotropy [FA] and mean diffusivity [MD]) and histopathology measures were obtained from 2 tracts: the anterior thalamic radiation and inferior longitudinal fasciculus. RESULTS FA was reduced in both tracts and MD was increased in cases with CAA compared to controls. Regional FA was significantly correlated with tissue rarefaction, myelin density, axonal density, and white matter microinfarcts. MD correlated significantly with tissue rarefaction, myelin density, and white matter microinfarcts, but not axonal density. FA and MD did not correlate with oligodendrocytes, astrocytes, or gliosis. Multivariate analysis revealed that tissue rarefaction (β = -0.32 ± 0.12, p = 0.009) and axonal density (β = 0.25 ± 0.12, p = 0.04) were both independently associated with FA, whereas myelin density was independently associated with MD (β = -0.32 ± 0.12, p = 0.013). Finally, we found an association between increased MD in the frontal white matter and CAA severity in the frontal cortex (p = 0.035). CONCLUSIONS These results suggest that overall tissue loss, and in particular axonal and myelin loss, are major components underlying CAA-related alterations in DTI properties observed in living patients. The findings allow for a more mechanistic interpretation of DTI parameters in small vessel disease and for mechanism-based selection of candidate treatments to prevent vascular cognitive impairment.
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Affiliation(s)
- Susanne J van Veluw
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown.
| | - Yael D Reijmer
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown
| | - Andre J van der Kouwe
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown
| | - Andreas Charidimou
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown
| | - Grace A Riley
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown
| | - Alexander Leemans
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown
| | - Brian J Bacskai
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown
| | - Matthew P Frosch
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown
| | - Anand Viswanathan
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown
| | - Steven M Greenberg
- From the J. Philip Kistler Stroke Research Center, Department of Neurology (S.J.v.V., Y.D.R., A.C., G.A.R., A.V., S.M.G.), and Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital and Harvard Medical School, Boston; MassGeneral Institute for Neurodegenerative Disease (S.J.v.V., B.J.B., M.P.F.), Charlestown Navy Yard, MA; Department of Neurology, Brain Center Rudolf Magnus (Y.D.R.), and Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Athinoula A. Martinos Center for Biomedical Imaging (A.J.v.d.K.), Department of Radiology, Massachusetts General Hospital, Charlestown
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Charidimou A, Boulouis G, Roongpiboonsopit D, Xiong L, Pasi M, Schwab KM, Rosand J, Gurol ME, Greenberg SM, Viswanathan A. Cortical superficial siderosis and recurrent intracerebral hemorrhage risk in cerebral amyloid angiopathy: Large prospective cohort and preliminary meta-analysis. Int J Stroke 2019; 14:723-733. [PMID: 30785378 DOI: 10.1177/1747493019830065] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND We aimed to investigate cortical superficial siderosis as an MRI predictor of lobar intracerebral hemorrhage (ICH) recurrence risk in cerebral amyloid angiopathy (CAA), in a large prospective MRI cohort and a systematic review. METHODS We analyzed a single-center MRI prospective cohort of consecutive CAA-related ICH survivors. Using Kaplan-Meier and Cox regression analyses, we investigated cortical superficial siderosis and ICH risk, adjusting for known confounders. We pooled data with eligible published cohorts in a two-stage meta-analysis using random effects models. Covariate-adjusted hazard rations (adj-HR) from pre-specified multivariable Cox proportional hazard models were used. RESULTS The cohort included 240 CAA-ICH survivors (cortical superficial siderosis prevalence: 36%). During a median follow-up of 2.6 years (IQR: 0.9-5.1 years) recurrent ICH occurred in 58 patients (24%). In prespecified multivariable Cox regression models, cortical superficial siderosis presence and disseminated cortical superficial siderosis were independent predictors of increased symptomatic ICH risk at follow-up (HR: 2.26; 95% CI: 1.31-3.87, p = 0.003 and HR: 3.59; 95% CI: 1.96-6.57, p < 0.0001, respectively). Three cohorts including 443 CAA-ICH patients in total were eligible for meta-analysis. During a mean follow-up of 2.5 years (range: 2-3 years) 92 patients experienced recurrent ICH (pooled risk ratio: 6.9% per year, 95% CI: 4.2%-9.7% per year). In adjusted pooled analysis, any cortical superficial siderosis and disseminated cortical superficial siderosis were the only independent predictors associated with increased lobar ICH recurrence risk (adj-HR: 2.4; 95% CI: 1.5-3.7; p < 0.0001, and adj-HR: 4.4; 95% CI: 2-9.9; p < 0.0001, respectively). CONCLUSIONS In CAA-ICH patients, cortical superficial siderosis presence and extent are the most important MRI prognostic risk factors for lobar ICH recurrence. These results can help guide clinical decision making in patients with CAA.
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Affiliation(s)
- Andreas Charidimou
- Department of Neurology, Hemorrhagic Stroke Research Program, JPK Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Gregoire Boulouis
- Department of Neurology, Hemorrhagic Stroke Research Program, JPK Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Duangnapa Roongpiboonsopit
- Department of Neurology, Hemorrhagic Stroke Research Program, JPK Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Division of Neurology, Faculty of Medicine, Department of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Li Xiong
- Department of Neurology, Hemorrhagic Stroke Research Program, JPK Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Marco Pasi
- Department of Neurology, Hemorrhagic Stroke Research Program, JPK Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Kristin M Schwab
- Department of Neurology, Hemorrhagic Stroke Research Program, JPK Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Rosand
- Department of Neurology, Hemorrhagic Stroke Research Program, JPK Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Division of Neurocritical Care and Emergency Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - M Edip Gurol
- Department of Neurology, Hemorrhagic Stroke Research Program, JPK Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Steven M Greenberg
- Department of Neurology, Hemorrhagic Stroke Research Program, JPK Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Anand Viswanathan
- Department of Neurology, Hemorrhagic Stroke Research Program, JPK Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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