Prevalence of non-haemorrhagic CAA markers in a memory clinic cohort

Abstract

Introduction: The inclusion of non-haemorrhagic imaging markers, namely a severe burden of enlarged perivascular spaces (EPVS) in the centrum semiovale (CSO) and a multispot pattern of white matter hyperintensities, improved the diagnostic accuracy of the recently updated diagnostic criteria for cerebral amyloid angiopathy (CAA, Boston Criteria 2.0). However, the prevalence of non-haemorrhagic markers in patients presenting with cognitive impairment remains unclear. Our objective was to determine the prevalence of newly proposed non-haemorrhagic imaging markers for CAA in a memory clinic cohort and to investigate possible associations with other clinical features Methods: A total of 622 patients from a memory clinic cohort who had undergone MRI and had available cerebrospinal fluid (CSF) neurodegeneration biomarkers. Severe EPVS in CSO and the presence of a multispot pattern were determined visually by two independent raters, blinded to clinical information, using validated Methods: Through multivariate analyses, we investigated the correlation between non-haemorrhagic imaging markers and various demographic, clinical, and neurodegeneration biomarker features. Results: The average age at diagnosis was 71 years, and 50% of patients were female. Most patients had mild cognitive impairment (56%). By applying the updated Boston criteria 2.0, the number of patients with possible CAA increased from 51 to 306. Severe EPVS in CSO was found in 53% of the sample and a multispot pattern was found in 38%. Factors such as age (OR 1.04 95%CI 1.01-1.07), female sex (OR 1.68 95%CI 1.11-2.54), and CAA diagnosis (Boston criteria 1.5, OR 2.11 95%CI 1.02-4.35) were independently associated with an increased likelihood of non-haemorrhagic CAA markers. However, the ASCVD 10-year risk (OR 1.01 95%CI 0.99-1.03), CSF Aβ1-42 levels (OR 1.00 95%CI 0.99-1.00) and clinical severity (CDR OR 1.19 95%CI 0.76-1.85) did not have a significant impact (Fig. 1). Discussion: More than half of the patients in our memory clinic cohort exhibited non-haemorrhagic markers of CAA, resulting in a notable rise in the number of patients who met the updated criteria for possible CAA. In this cohort, non-haemorrhagic markers were not specific of CAA, but the association between non-haemorrhagic and haemorrhagic markers of CAA supports a link between non- haemorrhagic markers and Aβ vascular deposition.