Stroke: The main etiology of cerebral hemorrhage in the elderly: longitudinal development of hereditary CAA magnetic resonance markers and cognitive ability

Cerebrovascular amyloid disease (CAA) is one of the main causes of spontaneous cerebral hemorrhage in the elderly .
Most patients are admitted to hospital due to cerebral hemorrhage, and the recurrence rate of CAA-related cerebral hemorrhage is high.
Patient prognosis is particularly important
.

The main imaging manifestations of CAA include lobar hemorrhage, cerebral microhemorrhage, cerebral convex subarachnoid hemorrhage, and cerebral surface iron deposition.
The susceptibility-weighted imaging sequence can be routinely used in clinic to increase the detection rate of CAA lesions
.
Among them, β-amyloid (Aβ) deposition in the cortex and leptomeningeal vessels is the main pathological feature of CAA

To this end, scholars from Leiden University in the Netherlands took advantage of the unique opportunity provided by the study of Dutch-type hereditary cerebral amyloid angiopathy (D-CAA) to determine the longitudinal development of CAA biomarkers in the presymptomatic and symptomatic phases of the disease.
Results Published in Stroke Magazine
.

In this longitudinal case-control study, MRI markers and cognitive performance were assessed in 10 asymptomatic and 6 symptomatic D-CAA mutation carriers and 20 control subjects at baseline and 4 years later.
assessment
.
These MRI markers include hemorrhagic and ischemic manifestations, measures of cerebral blood flow, and vasomotor responsiveness to visual stimuli

The results showed that in asymptomatic D-CAA mutation carriers, vasomotor reactivity showed a decrease in blood oxygen level-dependent amplitude with time (P=0.
011) and a prolonged time to peak (P<0.
001)
.
In contrast, no significant changes were found in hemorrhagic markers, ischemic markers, cerebral blood flow, and cognitive performance

Amplitude changes in blood oxygen levels since asymptomatic D-caa carriers

Our findings suggest that cerebrovascular reactivity, as measured by blood oxygen level-dependent amplitude and time to peak to visual stimuli, progressively worsens during the asymptomatic phase of D-CAA and can therefore be considered a marker of disease progression

references:

Longitudinal Progression of Magnetic Resonance Imaging Markers and Cognition in Dutch-Type Hereditary Cerebral Amyloid Angiopathy.