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Anisetti B, Greco E, Stojadinovic E, Goldstein ED, Sakusic A, Badi MK, Liu MD, Lin MP, Chiang CC, Elahi FM, Worrall BB, Petrosian D, Ross O, Meschia JF. Novel grading system for CADASIL severity: A multicenter cross-sectional study. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 5:100170. [PMID: 37441712 PMCID: PMC10333271 DOI: 10.1016/j.cccb.2023.100170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 07/15/2023]
Abstract
Background Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited progressive cerebral microangiopathy with considerable phenotypic variability. The purpose of this study was to describe the generalizability of a recently proposed grading system of CADASIL across multiple centers in the United States. Methods Electronic medical records (EMR) of an initial neurological assessment of adult patients with confirmed CADASIL were reviewed across 5 tertiary referral medical centers with expertise in CADASIL. Demographic, vascular risk factors, and neuroimaging data were abstracted from EMR. Patients were categorized into groups according to the proposed CADASIL grading system: Grade 0 (asymptomatic), Grade 1 (migraine only), Grade 2 (stroke, TIA, or MCI), Grade 3 (gait assistance or dementia), and Grade 4 (bedbound or end-stage). Inter-rater reliability (IRR) of grading was tested in a subset of cases. Results We identified 138 patients with a mean age of 50.9 ± 13.1 years, and 57.2% were female. The IRR was acceptable over 33 cases (κ=0.855, SD 0.078, p<0.001) with 81.8% being concordant. There were 15 patients (10.9%) with Grade 0, 50 (36.2%) with Grade 1, 61 (44.2%) with Grade 2, 12 (8.7%) with Grade 3, and none with Grade 4. Patients with a lower severity grade (grade 0 vs 3) tended to be younger (49.5 vs. 61.9 years) and had a lower prevalence of hypertension (50% vs. 20%, p = 0.027) and diabetes mellitus (0% vs. 25%, p = 0.018). A higher severity grade was associated with an increased number of vascular risk factors (p = 0.02) and independently associated with hypertension and diabetes (p<0.05). Comparing Grade 0 vs. 3, cortical thickness tended to be greater (2.06 vs. 1.87 mm; p = 0.06) and white matter hyperintensity volume tended to be lower (54.7 vs. 72.5 ml; p = 0.73), but the differences did not reach significance. Conclusion The CADASIL severity grading system is a pragmatic, reliable system for characterizing CADASIL phenotype that does not require testing beyond that done in standard clinical practice. Higher severity grades tended to have a higher vascular risk factor burden. This system offers a simple method of categorizing CADASIL patients which may help to describe populations in observational and interventional studies.
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Affiliation(s)
| | - Elena Greco
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Eric D. Goldstein
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Amra Sakusic
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Michael D Liu
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Fanny M Elahi
- Department of Neurology, University of California, San Francisco, California, USA
| | - Bradford B Worrall
- Department of Neurology, University of Virginia, Charlottesville, Virginia, USA
| | - Derek Petrosian
- Department of Neurology, University of Virginia, Charlottesville, Virginia, USA
| | - Owen Ross
- Mayo Clinic College of Medicine and Science, Mayo Clinic, Jacksonville, Florida, USA
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Muppa J, Yaghi S, Goldstein ED. Antiplatelet use and CADASIL: a retrospective observational analysis. Neurol Sci 2023:10.1007/s10072-023-06773-1. [PMID: 36966219 DOI: 10.1007/s10072-023-06773-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/20/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVES Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is hallmarked by age-dependent accumulation of microangiopathy with antiplatelet medications commonly used for stroke prevention though without known therapeutic benefit. Our objective was to identify whether antiplatelet therapy impacted the incidence of acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) in those with reported CADASIL. MATERIALS AND METHODS Owing to the rarity of the disease, we performed a retrospective study of anonymized data from the international TriNetX Research Network (Oct 2015 through January 2021). Individuals had an ICD-10 code (I67.850) for CADASIL. The primary outcome was incidence of validated ICD-10 codes for AIS (I63) and ICH (I61) linked with unique hospital admission encounters. The primary exposure was use of an antiplatelet medication for at least 1 month prior to the primary outcome. Age-adjusted logistic regression was used for likelihood ratios. RESULTS We identified 455 individuals: 36% female, 40 (8.8%) antiplatelet exposed. Those with antiplatelet use were older (antiplatelet: 61±12 years vs. unexposed: 57±14 years, p = 0.034) with similar rates of AIS [antiplatelet: 23%(9/40) vs. unexposed: 14%(60/415); p=0.18] and ICH [antiplatelet: 3%(1/40) vs. unexposed: 5%(19/415); p = 0.54) and without significant impact on age-adjusted AIS likelihood (OR 1.62, 95%CI 0.73-3.60, p=0.23). Sample size precluded ICH regression analyses. CONCLUSIONS Our data suggests that antiplatelet use did not significantly impact incidence of AIS or ICH within a group of individuals with suspected CADASIL This study highlights the need for further understanding of the pathophysiology of CADASIL to lead to disease modifying treatments.
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Affiliation(s)
- Jayachandra Muppa
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Shadi Yaghi
- Department of Neurology, Warren Alpert Medical School of Brown University, 593 Eddy St, APC 5th Floor, Providence, RI, 02903, USA
| | - Eric D Goldstein
- Department of Neurology, Warren Alpert Medical School of Brown University, 593 Eddy St, APC 5th Floor, Providence, RI, 02903, USA.
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Ding F. Editorial commentary on the special issue of glia and neurological diseases. J Biomed Res 2022; 36:297-298. [PMID: 36165296 PMCID: PMC9548437 DOI: 10.7555/jbr.36.20220800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fengfei Ding
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Institutes of Brain Science, Shanghai Medical College, Fudan University, Shanghai 200032, China
- Fengfei Ding, Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Institutes of Brain Science, Shanghai Medical College, Fudan University, No. 130 Dong An Road, Xuhui District, Shanghai 200032, China. Tel: +86-21-54237228, E-mail:
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