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  • 1
    Online Resource
    Online Resource
    Cerebrovascular Reactivity Across the Entire Brain in Cerebral Amyloid Angiopathy
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Neurology Vol. 98, No. 17 ( 2022-04-26), p. e1716-e1728
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 98, No. 17 ( 2022-04-26), p. e1716-e1728
    Abstract: Reduced cerebrovascular reactivity is proposed to be a feature of cerebral amyloid angiopathy (CAA) but has not been measured directly. Employing a global vasodilatory stimulus (hypercapnia), this study assessed the relationships between cerebrovascular reactivity and MRI markers of CAA and cognitive function. Methods In a cross-sectional study, individuals with probable CAA, mild cognitive impairment, or dementia due to Alzheimer disease and healthy controls underwent neuropsychological testing and an MRI that included a 5% carbon dioxide challenge. Cerebrovascular reactivity was compared across groups controlling for age, sex, and the presence of hypertension, and its associations with MRI markers of CAA in participants with CAA and with cognition across all participants were determined using multivariable linear regression adjusting for group, age, sex, education, and the presence of hypertension. Results Cerebrovascular reactivity data (mean ± SD) were available for 26 participants with CAA (9 female; 74.4 ± 7.7 years), 19 participants with mild cognitive impairment (5 female; 72.1 ± 8.5 years), 12 participants with dementia due to Alzheimer disease (4 female; 69.4 ± 6.6 years), and 39 healthy controls (30 female; 68.8 ± 5.4 years). Gray and whiter matter reactivity averaged across the entire brain was lower in participants with CAA and Alzheimer disease dementia compared to healthy controls, with a predominantly posterior distribution of lower reactivity in both groups. Higher white matter hyperintensity volume was associated with lower white matter reactivity (standardized coefficient [β], 95% CI −0.48, −0.90 to −0.01). Higher gray matter reactivity was associated with better global cognitive function (β 0.19, 0.03–0.36), memory (β 0.21, 0.07–0.36), executive function (β 0.20, 0.02–0.39), and processing speed (β 0.27, 0.10–0.45) and higher white matter reactivity was associated with higher memory (β 0.22, 0.08–0.36) and processing speed (β 0.23, 0.06–0.40). Conclusions Reduced cerebrovascular reactivity is a core feature of CAA and its assessment may provide an additional biomarker for disease severity and cognitive impairment.
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000200136
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 2
    Online Resource
    Online Resource
    Cerebral amyloid angiopathy and visuospatial functioning: Analysis of the clock drawing test
    Wiley ; 2021
    In:  Alzheimer's & Dementia Vol. 17, No. S6 ( 2021-12)
    Details
    In: Alzheimer's & Dementia, Wiley, Vol. 17, No. S6 ( 2021-12)
    Abstract: Cerebral amyloid angiopathy (CAA) contributes to cognitive impairment as well as dementia in the elderly. In clinical cohorts, symptomatic CAA is associated with impairments in executive function and processing speed. Because CAA severity tends to be highest in the occipital and posterior temporal and parietal lobes, it may also affect visuospatial function. We hypothesized that participants with a clinical diagnosis of CAA will have impaired performance on tests of visuospatial function when compared to control, mild cognitive impairment (MCI) and Alzheimer’s disease (AD) participants. Method Participants with CAA presented with lobar intracerebral hemorrhage, transient focal neurological episodes, or mild cognitive impairment; met Boston criteria for probable CAA; and did not have dementia. Clocks were scored based on a published 20‐point system (Mendez, JAGS 1992). Clock items were subcategorized by general contours, number items, and hand items (Mendez, JAGS 1992); and by a subset of 9 items correlated in prior literature with visuospatial function and temporal‐parietal hypoperfusion (visuospatial items). Result Data from 53 CAA without dementia, 43 MCI, 30 AD with mild dementia (MMSE ≥20), and 40 control participants were analyzed (mean age 71.6 [SD 7.5]; 47% women). Compared to controls, CAA participants performed significantly worse on total score, hand items, and visuospatial items (Table 1). AD participants performed worse than controls on all components except general contour, and MCI participants did not differ from controls. Among CAA participants, total and visuospatial scores did not correlate with history of stroke, number of microbleeds, or white matter hyperintensity volume (p 〉 0.10). Conclusion Mean performance on the clock drawing test is lower in CAA patients without dementia than controls, suggesting visuospatial impairment. This impairment may be related to vascular amyloid deposition in posterior brain regions; however, it was not correlated with typical markers of CAA severity suggesting it may be an early but not necessarily progressive feature. Future research should investigate the mechanisms of visuospatial impairment in CAA—including whether it is related to posterior white matter damage or parieto‐occipital atrophy—and its association with daily function and risk for cognitive decline.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    URL: Article
    DOI: 10.1002/alz.v17.S6
    DOI: 10.1002/alz.053014
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2201940-6
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  • 3
    Online Resource
    Online Resource
    Gait in Cerebral Amyloid Angiopathy
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of the American Heart Association Vol. 11, No. 19 ( 2022-10-04)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 11, No. 19 ( 2022-10-04)
    Abstract: Gait is a complex task requiring coordinated efforts of multiple brain networks. To date, there is little evidence on whether gait is altered in cerebral amyloid angiopathy (CAA). We aimed to identify impairments in gait performance and associations between gait impairment and neuroimaging markers of CAA, cognition, and falls. Methods and Results Gait was assessed using the Zeno Walkway during preferred pace and dual task walks, and grouped into gait domains (Rhythm, Pace, Postural Control, and Variability). Participants underwent neuropsychological testing and neuroimaging. Falls and fear of falling were assessed through self‐report questionnaires. Gait domain scores were standardized and analyzed using linear regression adjusting for age, sex, height, and other covariates. Participants were patients with CAA (n=29), Alzheimer disease with mild dementia (n=16), mild cognitive impairment (n=24), and normal elderly controls (n=47). CAA and Alzheimer disease had similarly impaired Rhythm, Pace, and Variability, and higher dual task cost than normal controls or mild cognitive impairment. Higher Pace score was associated with better global cognition, processing speed, and memory. Gait measures were not correlated with microbleed count or white matter hyperintensity volume. Number of falls was not associated with gait domain scores, but participants with low fear of falling had higher Pace (odds ratio [OR], 2.61 [95% CI, 1.59–4.29] ) and lower Variability (OR, 1.64 [95% CI, 1.10–2.44]). Conclusions CAA is associated with slower walking, abnormal rhythm, and greater gait variability than in healthy controls. Future research is needed to identify the mechanisms underlying gait impairments in CAA, and whether they predict future falls.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.121.025886
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2653953-6
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  • 4
    Online Resource
    Online Resource
    Mediators of cognitive impairment in cerebral amyloid angiopathy
    SAGE Publications ; 2023
    In:  International Journal of Stroke Vol. 18, No. 1 ( 2023-01), p. 78-84
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 18, No. 1 ( 2023-01), p. 78-84
    Abstract: Cerebral amyloid angiopathy (CAA) is associated with cognitive decline. CAA has diverse impacts on brain structure and function; however, the brain lesions that mediate the association of CAA with cognition are not understood well. Aims: To determine the degree to which CAA neuroimaging biomarkers mediate the association of CAA with cognitive dysfunction. Methods: We analyzed cross-sectional data of patients with probable CAA and controls without cognitive impairment from the Functional Assessment of Vascular Reactivity study. Neuropsychological tests were grouped into domains of memory, executive function, and processing speed. Candidate CAA neuroimaging biomarkers were pre-specified based on prior literature, consisting of white matter hyperintensity volume, peak width of skeletonized mean diffusivity (PSMD) on diffusion tensor magnetic resonance imaging (MRI), cerebrovascular reactivity (CVR), cortical thickness, and cortical thickness in a meta-region of interest typically affected by Alzheimer’s disease (AD). Cognitive scores and neuroimaging markers were standardized and reported in relation to values in controls. Mediation analysis was used to estimate the total effect of CAA on cognition and the proportion of the total effect that was mediated by neuroimaging biomarkers, controlling for age, sex, and education. Results: There were 131 participants (67 CAA and 64 controls). Mean age was 72.1 ± 7.7 years, and 54.2% were women. As expected, compared to controls, CAA was associated with lower cognition. In mediation analyses, CAA had direct unmediated effects of 48%, 46%, and 52% on all three cognitive domains. The association of CAA with memory was partially mediated by CVR and PSMD, accounting for 18% and 36% of the total effect of CAA. The association of CAA with executive function was partially mediated by PSMD and mean cortical thickness in the AD meta-region of interest (ROI), accounting for 33% and 31% of the total effect of CAA. The association of CAA with processing speed was partially mediated by CVR and PSMD, accounting for 8% and 34% of the total effect of CAA. Among CAA participants, the presence of cortical superficial siderosis was associated with lower processing speed. Conclusion: Altered white matter diffusivity (i.e. PSMD), CVR, and atrophy, taken together, account for about half the effect of CAA on cognition.
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1177/17474930221099352
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2211666-7
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