Predictors for Late Post-Intracerebral Hemorrhage Dementia in Patients with Probable Cerebral Amyloid Angiopathy

Article type: Research Article

Authors: Xiong, Li^{a; *} | Charidimou, Andreas^a | Pasi, Marco^a | Boulouis, Gregoire^b | Pongpitakmetha, Thanakit^{a; c} | Schirmer, Markus D.^{a; d; e} | Singh, Sanjula^a | Benson, Emily^a | Gurol, Edip M.^a | Rosand, Jonathan^a | Greenberg, Steven M.^a | Biffi, Alessandro^a | Viswanathan, Anand^a

Affiliations: [a] Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA | [b] Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France | [c] Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand | [d] Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, Boston, MA, USA | [e] Department of Population Health Sciences, German Centre for Neurodegenerative Diseases (DZNE), Germany

Correspondence: [*] Correspondence to: Li Xiong, MD, PhD, The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, 175 Cambridge St., Suite 300, Boston, MA 02114, USA. Tel.: +1 617 444 1324; E-mail: may.lixiong@gmail.com.

Abstract: Background and Objective:Cerebral amyloid angiopathy (CAA) accounts for the majority of lobar intracerebral hemorrhage (ICH); however, the risk factors for dementia conversion after ICH occurrence in CAA patients are unknown, especially in the long-term period after ICH. Therefore, we aimed to unravel the predictors for late post-ICH dementia (6 months after ICH event) in probable CAA patients. Methods:From a large consecutive MRI prospective cohort of spontaneous ICH (2006–2017), we identified probable CAA patients (modified Boston criteria) without dementia 6 months post-ICH. Cognitive outcome during follow-up was determined based on the information from standardized clinical visit notes. We used Cox regression analysis to investigate the association between baseline demographic characteristics, past medical history, MRI biomarkers, and late post-ICH dementia conversion (dementia occurred after 6 months). Results:Among 97 non-demented lobar ICH patients with probable CAA, 25 patients (25.8%) developed dementia during a median follow-up time of 2.5 years (IQR 1.5–3.8 years). Pre-existing mild cognitive impairment, increased white matter hyperintensities (WMH) burden, the presence of disseminated cortical superficial siderosis (cSS), and higher total small vessel disease score for CAA were all independent predictors for late dementia conversion. Conclusion:In probable CAA patients presenting with lobar ICH, high WMH burden and presence of disseminated cSS are useful neuroimaging biomarkers for dementia risk stratification. These findings have implications for clinical practice and future trial design.

Keywords: Cerebral amyloid angiopathy, cerebral hemorrhage, cerebral small vessel disease, dementia

DOI: 10.3233/JAD-190346

Journal: Journal of Alzheimer's Disease, vol. 71, no. 2, pp. 435-442, 2019