Sex differences in risk factors, burden, and outcomes of cerebrovascular disease in Alzheimer's disease populations

Morrison, Cassandra; Dadar, Mahsa; Collins, Donald Louis; ,

doi:10.1002/alz.13452

Cited by 4 publications

(1 citation statement)

References 54 publications

(137 reference statements)

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“…However, there is emerging evidence, consistent with our observation, that women with and without cognitive impairment have a greater WMH burden, 44 , 45 which may reduce their resilience to other types of neuropathology. 46 …”

Section: Discussionmentioning

confidence: 99%

Non‐hemorrhagic imaging markers of cerebral amyloid angiopathy in memory clinic patients

Costa,

Albrecht,

Reich

et al. 2024

Alzheimer's & Dementia

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INTRODUCTIONThe Boston criteria v2.0 for cerebral amyloid angiopathy (CAA) incorporated non‐hemorrhagic imaging markers. Their prevalence and significance in patients with cognitive impairment remain uncertain.METHODSWe studied 622 memory clinic patients with available magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) biomarkers. Two raters assessed non‐hemorrhagic markers, and we explored their association with clinical characteristics through multivariate analyses.RESULTSMost patients had mild cognitive impairment; median age was 71 years and 50% were female. Using the v2.0 criteria, possible or probable CAA increased from 75 to 383 patients. Sixty‐eight percent of the sample had non‐hemorrhagic CAA markers, which were independently associated with age (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.01–1.07), female sex (OR = 1.68, 95% CI = 1.11–2.54), and hemorrhagic CAA markers (OR = 2.11, 95% CI = 1.02–4.35).DISCUSSIONTwo‐thirds of patients from a memory clinic cohort had non‐hemorrhagic CAA markers, increasing the number of patients meeting the v2.0 CAA criteria. Longitudinal approaches should explore the implications of these markers, particularly the hemorrhagic risk in this population.Highlights The updated Boston criteria for cerebral amyloid angiopathy (CAA) now include non‐hemorrhagic markers. The prevalence of non‐hemorrhagic CAA markers in memory clinic patients is unknown. Two‐thirds of patients in our memory clinic presented non‐hemorrhagic CAA markers. The presence of these markers was associated with age, female sex, and hemorrhagic CAA markers. The hemorrhagic risk of patients presenting these type of markers remains unclear.

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Section: Discussionmentioning

confidence: 99%

Non‐hemorrhagic imaging markers of cerebral amyloid angiopathy in memory clinic patients

Costa,

Albrecht,

Reich

et al. 2024

Alzheimer's & Dementia

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Beyond Hypertension: Examining Variable Blood Pressure’s Role in Cognition and Brain Structure

Morrison,

Oliver,

Kamal

et al. 2024

The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences

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Objectives Hypertension or high blood pressure (BP) is one of the twelve modifiable risk factors that contribute to 40% of dementia cases that could be delayed or prevented. Although hypertension is associated with cognitive decline and structural brain changes, less is known about the long-term association between variable BP and cognitive/brain changes. This study examined the relationship between variable BP and longitudinal cognitive, white matter hyperintensity (WMH), gray matter (GM), and white matter (WM) volume change over time and post-mortem neuropathology. Methods A total of 4,606 participants (32,776 follow-ups) from RADC Research Resource Sharing Hub (RUSH) and 2,114 participants (9,827 follow-ups) from Alzheimer’s Disease Neuroimaging Initiative (ADNI) were included. Participants were divided into one of three groups: normal, high, or variable BP. Linear mixed models investigated the relationship between BP and cognition, brain structure, and neuropathology. Results Older adults with variable BP exhibited the highest rate of cognitive decline followed by high and then normal BP. Increased GM volume loss and WMH burden was also observed in variable compared to high and normal BP. In post-mortem neuropathology, both variable and high BP had increased rates compared to normal BP. All the results were consistent across the RUSH and ADNI participants, supporting the generalizability of the findings. Discussion Damages potentially associated with variable BP may reduce resilience to future dementia related pathology and increased risk of dementia more than that caused by high BP. Improved treatment and management of variable BP may help reduce cognitive decline in the older adult population.

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Sex-Specific Risk Factors and Clinical Dementia Outcomes for White Matter Hyperintensities in a large South Korean Cohort

Schweitzer,

Son,

Thurston

et al. 2024

Preprint

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Objective: White matter hyperintensities (WMH) on brain MRI images are the most common feature of cerebral small vessel disease (CSVD). Studies have yielded divergent findings on the modifiable risk factors for WMH and WMH’s impact on cognitive decline. Mounting evidence suggests sex differences in WMH burden and subsequent effects on cognition. Thus, we aimed to identify sex-specific modifiable risk factors for WMH. We then explored whether there were sex-specific associations of WMH to longitudinal clinical dementia outcomes. Methods: Participants aged 49–89 years were recruited at memory clinics and underwent a T2-weighted fluid-attenuated inversion recovery (FLAIR) 3T MRI scan to measure WMH volume. Participants were then recruited for two additional follow-up visits, 1–2 years apart, where clinical dementia rating sum of boxes (CDR-SB) scores were measured. We first explored which known modifiable risk factors for WMH were significant when tested for a sex-interaction effect. We additionally tested which risk factors were significant when stratified by sex. We then tested to see whether WMH is longitudinally associated with clinical dementia that is sex-specific. Results: The study utilized data from 713 participants (241 males, 472 females) with a mean age of 72.3 years and 72.8 years for males and females, respectively. 57.3% and 59.5% of participants were diagnosed with mild cognitive impairment (MCI) for males and females, respectively. 40.7% and 39.4% were diagnosed with dementia for males and females, respectively. Of the 713 participants, 181 participants had CDR-SB scores available for three longitudinal time points. Compared to males, females showed stronger association of age to WMH volume. Type 2 Diabetes was associated with greater WMH burden in females but not males. Finally, baseline WMH burden was associated with worse clinical dementia outcomes longitudinally in females but not in males. Discussion: Elderly females have an accelerated increase in cerebrovascular burden as they age, and subsequently are more vulnerable to clinical dementia decline due to CSVD. Additionally, females are more susceptible to the cerebrovascular consequences of diabetes. These findings emphasize the importance of considering sex when examining the consequences of CSVD. Future research should explore the underlying mechanisms driving these sex differences and personalized prevention and treatment strategies. Clinical trial registration: The BICWALZS is registered in the Korean National Clinical Trial Registry (Clinical Research Information Service; identifier, KCT0003391). Registration Date 2018/12/14.

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Sex differences in risk factors, burden, and outcomes of cerebrovascular disease in Alzheimer's disease populations

Cited by 4 publications

References 54 publications

Non‐hemorrhagic imaging markers of cerebral amyloid angiopathy in memory clinic patients

Non‐hemorrhagic imaging markers of cerebral amyloid angiopathy in memory clinic patients

Beyond Hypertension: Examining Variable Blood Pressure’s Role in Cognition and Brain Structure

Sex-Specific Risk Factors and Clinical Dementia Outcomes for White Matter Hyperintensities in a large South Korean Cohort

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