Application of an Imaging-Based Sum Score for Cerebral Amyloid Angiopathy to the General Population: Risk of Major Neurological Diseases and Mortality
Objective: To assess the relation between a sum score of imaging markers indicative of cerebral amyloid angiopathy (CAA) and cognitive impairment, stroke, dementia, and mortality in a general population.Methods: One thousand six hundred twenty-two stroke-free and dementia-free participants of the po...
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| Format: | Article |
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Frontiers Media S.A.
2019-12-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2019.01276/full |
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| author | Pinar Yilmaz Pinar Yilmaz Mohammad Arfan Ikram Mohammad Kamran Ikram Mohammad Kamran Ikram Wiro J. Niessen Wiro J. Niessen Anand Viswanathan Andreas Charidimou Meike W. Vernooij Meike W. Vernooij |
| author_facet | Pinar Yilmaz Pinar Yilmaz Mohammad Arfan Ikram Mohammad Kamran Ikram Mohammad Kamran Ikram Wiro J. Niessen Wiro J. Niessen Anand Viswanathan Andreas Charidimou Meike W. Vernooij Meike W. Vernooij |
| author_sort | Pinar Yilmaz |
| collection | DOAJ |
| description | Objective: To assess the relation between a sum score of imaging markers indicative of cerebral amyloid angiopathy (CAA) and cognitive impairment, stroke, dementia, and mortality in a general population.Methods: One thousand six hundred twenty-two stroke-free and dementia-free participants of the population-based Rotterdam Study (mean age 73.1 years, 54.3% women) underwent brain MRI (1.5 tesla) in 2005–2011 and were followed for stroke, dementia and death until 2016–2017. Four MRI markers (strictly lobar cerebral microbleeds, cortical superficial siderosis, centrum semiovale perivascular spaces, and white matter hyperintensities) were combined to construct the CAA sum score, ranging from 0 to 4. Neuropsychological testing measured during the research visit closest to scan date were used to assess general cognitive function and cognitive domains. The associations of the CAA sum score with cognition cross-sectionally and with stroke, dementia, and mortality longitudinally were determined using linear regression and Cox proportional hazard modeling adjusted for age, sex, hypertension, cholesterol, lipid lowering medication, atrial fibrillation, antithrombotic medication and APOE-ε2/ε4 carriership. Additionally, we accounted for competing risks of death due to other causes for stroke and dementia, and calculated absolute risk estimates.Results: During a mean follow-up of 7.2 years, 62 participants suffered a stroke, 77 developed dementia and 298 died. Participants with a CAA score of 1 showed a lower Mini-Mental-State-Exam (fully-adjusted mean difference −0.21, 95% CI (−0.42–0.00) compared to a score of 0. In general, for increased CAA scores we saw a lower g-factor. The age and sex-adjusted hazard ratios (HRs) per point increase of the CAA score were 1.41 for stroke (95% CI, 0.99–2.00), 1.19 for dementia (95% CI, 0.86–1.65), and 1.26 for mortality (95% CI, 1.07–1.48). The results for dementia and stroke risk did not differ after correcting for the competing risk of death. For all outcomes, higher CAA scores showed higher absolute risk estimates over 10 years.Conclusions: Our results suggest that in this community-dwelling population, a higher CAA score is related to cognitive impairment and a higher risk of stroke, dementia, and death. The composite CAA score can be used to practically quantify the severity of vascular brain injury. |
| first_indexed | 2024-04-12T06:12:45Z |
| format | Article |
| id | doaj.art-5a17a86f505948ccbf0f65922d963e38 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-12T06:12:45Z |
| publishDate | 2019-12-01 |
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| spelling | doaj.art-5a17a86f505948ccbf0f65922d963e382022-12-22T03:44:39ZengFrontiers Media S.A.Frontiers in Neurology1664-22952019-12-011010.3389/fneur.2019.01276493432Application of an Imaging-Based Sum Score for Cerebral Amyloid Angiopathy to the General Population: Risk of Major Neurological Diseases and MortalityPinar Yilmaz0Pinar Yilmaz1Mohammad Arfan Ikram2Mohammad Kamran Ikram3Mohammad Kamran Ikram4Wiro J. Niessen5Wiro J. Niessen6Anand Viswanathan7Andreas Charidimou8Meike W. Vernooij9Meike W. Vernooij10Department of Epidemiology, Erasmus Medical Center, Rotterdam, NetherlandsDepartment of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, NetherlandsDepartment of Epidemiology, Erasmus Medical Center, Rotterdam, NetherlandsDepartment of Epidemiology, Erasmus Medical Center, Rotterdam, NetherlandsDepartment of Neurology, Erasmus Medical Center, Rotterdam, NetherlandsDepartment of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, NetherlandsDepartment of Medical Informatics, Erasmus Medical Center, Rotterdam, NetherlandsDepartment of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, United StatesDepartment of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, United StatesDepartment of Epidemiology, Erasmus Medical Center, Rotterdam, NetherlandsDepartment of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, NetherlandsObjective: To assess the relation between a sum score of imaging markers indicative of cerebral amyloid angiopathy (CAA) and cognitive impairment, stroke, dementia, and mortality in a general population.Methods: One thousand six hundred twenty-two stroke-free and dementia-free participants of the population-based Rotterdam Study (mean age 73.1 years, 54.3% women) underwent brain MRI (1.5 tesla) in 2005–2011 and were followed for stroke, dementia and death until 2016–2017. Four MRI markers (strictly lobar cerebral microbleeds, cortical superficial siderosis, centrum semiovale perivascular spaces, and white matter hyperintensities) were combined to construct the CAA sum score, ranging from 0 to 4. Neuropsychological testing measured during the research visit closest to scan date were used to assess general cognitive function and cognitive domains. The associations of the CAA sum score with cognition cross-sectionally and with stroke, dementia, and mortality longitudinally were determined using linear regression and Cox proportional hazard modeling adjusted for age, sex, hypertension, cholesterol, lipid lowering medication, atrial fibrillation, antithrombotic medication and APOE-ε2/ε4 carriership. Additionally, we accounted for competing risks of death due to other causes for stroke and dementia, and calculated absolute risk estimates.Results: During a mean follow-up of 7.2 years, 62 participants suffered a stroke, 77 developed dementia and 298 died. Participants with a CAA score of 1 showed a lower Mini-Mental-State-Exam (fully-adjusted mean difference −0.21, 95% CI (−0.42–0.00) compared to a score of 0. In general, for increased CAA scores we saw a lower g-factor. The age and sex-adjusted hazard ratios (HRs) per point increase of the CAA score were 1.41 for stroke (95% CI, 0.99–2.00), 1.19 for dementia (95% CI, 0.86–1.65), and 1.26 for mortality (95% CI, 1.07–1.48). The results for dementia and stroke risk did not differ after correcting for the competing risk of death. For all outcomes, higher CAA scores showed higher absolute risk estimates over 10 years.Conclusions: Our results suggest that in this community-dwelling population, a higher CAA score is related to cognitive impairment and a higher risk of stroke, dementia, and death. The composite CAA score can be used to practically quantify the severity of vascular brain injury.https://www.frontiersin.org/article/10.3389/fneur.2019.01276/fullcerebral small vessel diseasecerebral amyloid angiopathysum scoreMRIcognitionstroke |
| spellingShingle | Pinar Yilmaz Pinar Yilmaz Mohammad Arfan Ikram Mohammad Kamran Ikram Mohammad Kamran Ikram Wiro J. Niessen Wiro J. Niessen Anand Viswanathan Andreas Charidimou Meike W. Vernooij Meike W. Vernooij Application of an Imaging-Based Sum Score for Cerebral Amyloid Angiopathy to the General Population: Risk of Major Neurological Diseases and Mortality Frontiers in Neurology cerebral small vessel disease cerebral amyloid angiopathy sum score MRI cognition stroke |
| title | Application of an Imaging-Based Sum Score for Cerebral Amyloid Angiopathy to the General Population: Risk of Major Neurological Diseases and Mortality |
| title_full | Application of an Imaging-Based Sum Score for Cerebral Amyloid Angiopathy to the General Population: Risk of Major Neurological Diseases and Mortality |
| title_fullStr | Application of an Imaging-Based Sum Score for Cerebral Amyloid Angiopathy to the General Population: Risk of Major Neurological Diseases and Mortality |
| title_full_unstemmed | Application of an Imaging-Based Sum Score for Cerebral Amyloid Angiopathy to the General Population: Risk of Major Neurological Diseases and Mortality |
| title_short | Application of an Imaging-Based Sum Score for Cerebral Amyloid Angiopathy to the General Population: Risk of Major Neurological Diseases and Mortality |
| title_sort | application of an imaging based sum score for cerebral amyloid angiopathy to the general population risk of major neurological diseases and mortality |
| topic | cerebral small vessel disease cerebral amyloid angiopathy sum score MRI cognition stroke |
| url | https://www.frontiersin.org/article/10.3389/fneur.2019.01276/full |
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