Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany.
JARA-Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich, Jülich, Germany and RWTH Aachen University, Aachen, Germany.
J Alzheimers Dis. 2021;79(4):1661-1672. doi: 10.3233/JAD-201218.
The overlap between cerebral amyloid angiopathy (CAA) and Alzheimer's disease (AD) is frequent and relevant for patients with cognitive impairment.
To assess the role of the diagnosis of CAA on the phenotype of amyloid-β (Aβ) positive patients from a university-hospital memory clinic.
Consecutive patients referred for suspected cognitive impairment, screened for Aβ pathological changes in cerebrospinal fluid (CSF), with available MRI and neuropsychological results were included. We determined the association between probable CAA and clinical, neuropsychological (at presentation and after a mean follow-up of 17 months in a sub-sample) and MRI (atrophy, white matter hyperintensities, perivascular spaces) characteristics.
Of 218 amyloid-positive patients, 8.3% fulfilled criteria for probable CAA. A multivariable logistic regression showed an independent association of probable CAA with lower Aβ1-42 (adjusted odds ratio [aOR] = 0.94, 95% confidence interval [95% CI] = 0.90-0.98, p = 0.003), and Aβ1-40 (aOR = 0.98, 95% CI=0.97-0.99 p = 0.017) levels in CSF, and presence of severe burden of enlarged perivascular spaces (EPVS) in the centrum semiovale (aOR = 3.67, 95% CI = 1.21-11.15, p = 0.022). Linear mixed-model analysis showed that both groups significantly deteriorated in global clinical severity, executive function and memory. Nevertheless, the presence of probable CAA did not differently affect the rate of cognitive decline.
The presence of probable CAA in Aβ positive patients was associated with lower Aβ1-42 and Aβ1-40 CSF levels and increased centrum semiovale EPVS burden, but did not independently influence clinical phenotype nor the rate of cognitive decline within our follow-up time window.
脑淀粉样血管病（CAA）和阿尔茨海默病（AD）之间存在重叠，这与认知障碍患者密切相关。
评估大学医院记忆诊所中，CAA 诊断对淀粉样蛋白-β（Aβ）阳性患者表型的影响。
连续纳入疑似认知障碍患者，这些患者进行了脑脊液（CSF）中 Aβ 病理变化的筛查，并且具有可用的 MRI 和神经心理学结果。我们确定了可能的 CAA 与临床、神经心理学（在亚组中在平均 17 个月的随访后进行评估）和 MRI（萎缩、白质高信号、血管周围间隙）特征之间的关联。
在 218 名 Aβ 阳性患者中，8.3%符合可能的 CAA 标准。多变量逻辑回归显示，可能的 CAA 与 CSF 中较低的 Aβ1-42（调整后优势比[aOR] = 0.94，95%置信区间[95%CI] = 0.90-0.98，p = 0.003）和 Aβ1-40（aOR = 0.98，95%CI=0.97-0.99，p = 0.017）水平以及半卵圆中心严重的血管周围间隙（EPVS）负荷（aOR = 3.67，95%CI = 1.21-11.15，p = 0.022）存在独立相关。线性混合模型分析显示，两组患者在全球临床严重程度、执行功能和记忆方面均显著恶化。然而，可能的 CAA 的存在并未对认知衰退的速度产生不同影响。
在 Aβ 阳性患者中，可能的 CAA 的存在与较低的 Aβ1-42 和 Aβ1-40 CSF 水平以及增加的半卵圆中心 EPVS 负荷相关，但在我们的随访时间窗口内，并未独立影响临床表型或认知衰退的速度。
