Neuropsychological Effects of Cerebral Amyloid Angiopathy

Schrag, Matthew; Kirshner, Howard S.

doi:10.1007/s11910-016-0674-1

Cited by 22 publications

(7 citation statements)

References 42 publications

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“…16,17 The presence of WMD on imaging is a useful biomarker for compromised cognitive performance, particularly on measures of memory and processing speed. 17,18 Common pathologic correlates of WMD include those commonly implicated in neurodegeneration, such as elevated markers of axonal damage, the presence of activated microglia, and disorganization of aquaporin-4 localization on vessel-associated astrocytes. [19][20][21][22] Mechanisms by which WMD may exert a negative effect on outcomes following an acute stroke are multifold.…”

Section: Discussionmentioning

confidence: 99%

White Matter Disease and Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke

Mistry¹,

Mistry²,

Mehta

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: The increased severity of white matter disease is associated with worse outcomes and an increased rate of intracerebral hemorrhage in patients with ischemic stroke undergoing thrombolytic treatment. However, whether white matter disease is associated with outcomes in patients undergoing endovascular treatment remains unclear. MATERIALS AND METHODS: In this prespecified exploratory analysis of our prospective multi-institutional study that enrolled consecutive adult patients with anterior circulation ischemic stroke undergoing endovascular treatment from November 2017 to September 2018, we compared the following outcomes between patients with none-to-minimal (van Swieten score, 0-2) and moderate-to-severe (van Swieten score, 3-4) white matter disease using logistic regression: 90-day mRS 3-6, death, intracerebral hemorrhage, successful recanalization, and early neurologic recovery. RESULTS: Of the 485 patients enrolled in the Blood Pressure after Endovascular Stroke Therapy (BEST) study, 389 had white matter disease graded (50% women; median age, 68 years; range, 58-79 years). A van Swieten score of 3-4 (n ¼ 74/389, 19%) was associated with a higher rate of 90-day mRS of 3-6 (45% versus 18%; adjusted OR, 2.73; 95% CI, 1.34-5.93; P ¼ .008). Although the death rate was higher in patients with van Swieten scores of 3-4 (26% versus 15%), the adjusted likelihood was not significantly different (adjusted OR, 1.14; 95% CI, 0.56-2.26; P ¼ .710). Ordered regression revealed a shift toward worse mRS scores with increasing van Swieten scores (adjusted common OR, 3.04; 95% CI, 1.93-4.84; P , .001). No associations between white matter disease severity and intracerebral hemorrhage, successful recanalization, and early neurologic recovery were observed. CONCLUSIONS: Moderate-to-severe white matter disease is associated with worse outcomes in patients undergoing endovascular treatment without a significant increase in hemorrhagic complications. Studies comparing patients with and without endovascular treatment are necessary to determine whether the benefit of endovascular treatment is attenuated with greater white matter disease. ABBREVIATIONS: aOR ¼ adjusted OR; EVT ¼ endovascular treatment; ICH ¼ intracerebral hemorrhage; VSS ¼ van Swieten score; WMD ¼ white matter disease E ndovascular treatment (EVT) drastically improves outcomes for select patients with an acute large-vessel occlusion and is the treatment technique with the highest level of evidence according to the most recent guidelines. 1,2 Thus, the use of EVT as the definitive treatment technique for large-vessel occlusion strokes is increasing. 3 Moreover, the indications for EVT are expanding to populations that were previously thought to not derive many benefits from EVT, such as those with delayed presentation. 4,5 Additional populations that may derive benefit are also under study, such as those with a large infarct core, 6,7 older age, 8 and low NIHSS scores. 9 White matter disease (WMD) is easily detectable on baseline routine imaging per...

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Section: Discussionmentioning

confidence: 99%

White Matter Disease and Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke

Mistry¹,

Mistry²,

Mehta

et al. 2020

AJNR Am J Neuroradiol

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“…Despite the clinical observation of cognitive impairment in CAA, the frequency, severity, and specific cognitive profile of CAA patients are not well understood (Schrag and Kirshner, 2016). To address this question, a pilot study reported neuropsychological and neuroimaging data from an ongoing prospective cohort (Functional Assessment of Vascular Reactivity in CAA) (Case et al, 2016).…”

Section: Dementia and Cognitive Impairment In Cerebral Amyloid Angiopmentioning

confidence: 99%

Emerging concepts in sporadic cerebral amyloid angiopathy

Charidimou

Boulouis

Gurol

et al. 2017

Brain

378

339

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Sporadic cerebral amyloid angiopathy is a common, well-defined small vessel disease and a largely untreatable cause of intracerebral haemorrhage and contributor to age-related cognitive decline. The term 'cerebral amyloid angiopathy' now encompasses not only a specific cerebrovascular pathological finding, but also different clinical syndromes (both acute and progressive), brain parenchymal lesions seen on neuroimaging and a set of diagnostic criteria-the Boston criteria, which have resulted in increasingly detected disease during life. Over the past few years, it has become clear that, at the pathophysiological level, cerebral amyloid angiopathy appears to be in part a protein elimination failure angiopathy and that this dysfunction is a feed-forward process, which potentially leads to worsening vascular amyloid-β accumulation, activation of vascular injury pathways and impaired vascular physiology. From a clinical standpoint, cerebral amyloid angiopathy is characterized by individual focal lesions (microbleeds, cortical superficial siderosis, microinfarcts) and large-scale alterations (white matter hyperintensities, structural connectivity, cortical thickness), both cortical and subcortical. This review provides an interdisciplinary critical outlook on various emerging and changing concepts in the field, illustrating mechanisms associated with amyloid cerebrovascular pathology and neurological dysfunction.

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“…The etiology of CMH includes CAA, hypertension, Alz heimer's disease, vascular dementia and genetic microvascular disease, but the pattern of neuroimaging findings on SWI in IE is characteristic [19,20] . They are common and distributed broadly, but have a preference for the posterior circulation, particularly the cerebellum.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Microhemorrhages and Meningeal Siderosis in Infective Endocarditis

Malhotra

Schindler²,

Grory³

et al. 2016

Cerebrovasc Dis

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Objective: Patients with infective endocarditis (IE) frequently experience cerebral insults, and neurological involvement in IE has been reported to herald a worse prognosis. In this manuscript, we describe a distinctive pattern of findings on susceptibility-weighted imaging (SWI) sequences in subjects with IE. Methods: Patients with IE who underwent SWI MRI at an academic hospital from 2009 to 2014 were retrospectively analyzed. The pattern of findings was compared to SWI findings in groups of subjects with cerebral amyloid angiopathy (CAA) or severe hypertension. Results: Sixty-six subjects with IE were included; 64 (94%) had microhemorrhages and the average number per patient was 21.5. In 11 (17%) patients, microhemorrhages were the only neuroimaging abnormality. The majority of microhemorrhages were between 1 and 3 mm. In a direct comparison of gradient-echo T2* (GRE-T2*) and SWI, many microhemorrhages in this size range were not detected by GRE-T2*. Microhemorrhages in IE involved every part of the brain with a significant predilection for the cerebellum. This pattern was distinct from that seen in hypertension or CAA. Small subarachnoid hemorrhage or meningeal siderosis were also frequently detected in IE, but were not associated with mycotic aneurysms. Interpretation: SWI is a sensitive diagnostic technique for detecting infectious cerebral angiopathy in subjects with IE, producing a pattern of microhemorrhages that were distinct from other common microangiopathies.

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Neuropsychological Effects of Cerebral Amyloid Angiopathy

Cited by 22 publications

References 42 publications

White Matter Disease and Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke

White Matter Disease and Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke

Emerging concepts in sporadic cerebral amyloid angiopathy

Cerebral Microhemorrhages and Meningeal Siderosis in Infective Endocarditis

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