Hypertensive Arteriopathy and Cerebral Amyloid Angiopathy in Patients with Cognitive Decline and Mixed Cerebral Microbleeds
Hypertensive Arteriopathy and Cerebral Amyloid Angiopathy in Patients with Cognitive Decline and Mixed Cerebral Microbleeds
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DOI：
10.3233/jad-200992
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发表时间：
2020-01-01
影响因子：
4
通讯作者：
Tomimoto, Hidekazu
中科院分区：
文献类型：
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作者：
Ii, Yuichiro;Ishikawa, Hidehiro;Tomimoto, Hidekazu
背景资料：高血压动脉病（HA）和脑淀粉样血管病（CAA）可能有助于混合性脑微出血（CMB）的发展。最近，总的小血管疾病（SVD）评分HA和CAA提出，这是由一个组合的MRI标志物，以反映这些microangiopathies.Objective的整体严重程度确定的：我们调查是否总HA-SVD和CAA-SVD评分可以用来预测重叠的HA和CAA患者混合CMBs.Methods：53例混合CMB进行了回顾性分析。评估MRI标记物（CMB、腔隙、血管周围间隙、白色高信号[WMH]和皮质浅表铁质沉着[cSS]）。获得每例受试者的HA-SVD评分和CAA-SVD评分。结果：前后侧WMH评分呈正相关（rho = 0.449，p < 0.001）。在高CAA-SVD评分组中，肺叶优势CMB分布（p <0.001）和半卵圆中心腔隙（p < 0.001）的患病率以及顶枕叶WMH的严重程度（p = 0.004）显著较高。4例CAA-SVD评分高的患者出现cSS，表现为脑叶优势型CMB分布和严重的后部WMH。评估这两个分数可以预测HA和CAA在混合CMB个体中的重叠。CAA-SVD评分高的患者可能有一定程度的晚期CAA，特别是当观察到以肺叶为主的CMB、严重的后部WMH、肺叶腔隙或cSS时。
Background: Hypertensive arteriopathy (HA) and cerebral amyloid angiopathy (CAA) may contribute to the development of mixed cerebral microbleeds (CMBs). Recently, the total small vessel disease (SVD) scores for HA and CAA were proposed, which are determined by a combination of MRI markers to reflect overall severity of these microangiopathies.Objective: We investigated whether or not total HA-SVD and CAA-SVD scores could be used to predict overlap of HA and CAA in patients with mixed CMBs.Methods: Fifty-three subjects with mixed CMBs were retrospectively analyzed. MRI markers (CMBs, lacunes, perivascular space, white matter hyperintensity [WMH] and cortical superficial siderosis [cSS]) were assessed. The HA-SVD score and CAA-SVD score were obtained for each subject. Anterior or posterior WMH was also assessed using the age-related white matter changes scale.Results: The two scores were positively correlated (rho = 0.449,p < 0.001). The prevalence of lobar dominant CMB distribution (p < 0.001) and lacunes in the centrum semiovale (p < 0.001) and the severity of WMH in the parieto-occipital lobes (p = 0.004) were significantly higher in the high CAA-SVD score group. cSS was found in four patients with high CAA-SVD score who showed lobar-dominant CMB distribution and severe posterior WMH.Conclusion: Mixed CMBs are mainly due to HA. Assessing both two scores may predict the overlap of HA and CAA in individuals with mixed CMBs. Patients with a high CAA-SVD score may have some degree of advanced CAA, especially when lobar predominant CMBs, severe posterior WMH, lobar lacunes, or cSS are observed.