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Neuropsychological Effects of Cerebral Amyloid Angiopathy

  • Behavior (H Kirshner, Section Editor)
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Abstract

Cerebral amyloid angiopathy is a condition of the cerebral arterioles and to a lesser extent capillaries and veins, wherein beta-amyloid is deposited. In arterioles, this preferentially targets vascular smooth muscle cells and in the later stages undermines the stability of the vessel. This condition is frequently comorbid with Alzheimer’s disease and its role in cognitive impairment and dementia is a topic of considerable recent research. This article reviews recent literature which confirms that CAA independently contributes to cognitive impairment by potentiating the neurodegeneration of Alzheimer’s disease, by predisposing to microhemorrhagic and microischemic injury to the brain parenchyma, and by interfering with the autoregulation of CNS blood flow. In this review, we discuss the clinical presentation of cerebral amyloid angiopathy, with a focus on the neuropsychological manifestations of this vasculopathy.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Vinters HV, Gilbert JJ. Cerebral amyloid angiopathy: incidence and complications in the aging brain II. The distribution of amyloid vascular changes. Stroke. 1983;14:924–30.

    Article  CAS  PubMed  Google Scholar 

  2. Boyle PA, Yu L, Leurgans S, Wilson R, Bennett D, Schneider J. Cerebral amyloid angiopathy and cognitive outcomes in community based older persons. Neurology. 2015;85:1930–6. This important study confirmed the independent association of moderate and severe CAA with perceptual speed and episodic memory and further identified impairment in semantic memory and global cognition attributable to CAA pathology. This study found no cognitive correlate to capillary CAA.

    Article  CAS  PubMed  Google Scholar 

  3. Ferrer I, Boada Rovira M, Sanchez Guerra M, Rey M, Costa-Jussa F. Neuropathology and pathogenesis of encephalitis following amyloiid-beta immunization in Alzheimer’s disease. Brain Pathol. 2004;14:11–20.

    Article  CAS  PubMed  Google Scholar 

  4. Weller R, Subash M, Preston S, Mazanti I, Carare R. Perivascular drainage of amyloid-beta peptides from the brain and its failure in cerebral amyloid angiopathy and Alzheimer’s disease. Brain Pathol. 2008;18:253–66.

    Article  CAS  PubMed  Google Scholar 

  5. Schrag M, McAuley G, Pomakian J, et al. Correlation of hypointensities in susceptibility-weighted images to tissue histology in dementia patients with cerebral amyloid angiopathy: a postmortem MRI study. Acta Neuropathol. 2010;119:291–302.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Zabel M, Schrag M, Crofton A, et al. A shift in microglial beta-amyloid binding in Alzheimer’s disease is associated with cerebral amyloid angiopathy. Brain Pathol. 2013;23:390–401.

    Article  CAS  PubMed  Google Scholar 

  7. Walker DG, Dalsing-Hernandez JE, Lue LF. Human postmortem brain-derived cerebrovascular smooth muscle cells express all genes of the classical complement pathway: a potential mechanism for vascular damage in cerebral amyloid angiopathy and Alzheimer’s disease. Microvasc Res. 2008;75:411–9.

    Article  CAS  PubMed  Google Scholar 

  8. Zabel M, Schrag M, Mueller W, et al. Assessing candidate serum biomarkers for Alzheimer’s disease: a longitudinal study. J Alzheimers Dis. 2012;30:311–21.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Hernandez Guillamon M, Martinez Saez E, Delgado P, et al. MMP-2/MMP-9 plasma level and brain expression in cerebral amyloid angiopathy-associated hemorrhagic stroke. Brain Pathol. 2011;22:133–41.

    Article  PubMed  Google Scholar 

  10. Schrag M, Crofton A, Zabel M, et al. Effect of cerebral amyloid angiopathy on brain iron, copper and zinc in Alzheimer’s disease. J Alzheimers Dis. 2011;24:137–49.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Mueller C, Zhou W, VanMeter A, et al. The heme degradation pathway is a promising serum biomarker source for the early detection of Alzheimer’s disease. J Alzheimers Dis. 2010;19:1081–91.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Kawai M, Lakaria RN, Cras P, et al. Degeneration of vascular muscle cells in cerebral amyloid angiopathy of Alzheimer disease. Brain Res. 1993;623:142–6.

    Article  CAS  PubMed  Google Scholar 

  13. Charidimou A, Boulouis G, Haley K, et al. White matter hyperintensity patterns in cerebral amyloid agniopathy and hypertensive arteriopathy. Neurology. 2016;86:505–11.

    Article  CAS  PubMed  Google Scholar 

  14. Pfeifer LA, White LR, Ross GW, Petrovich H, Launer LJ. Cerebral amyloid angiopathy and cognitive function: the HAAS autopsy study. Neurology. 2002;58:1629–34.

    Article  CAS  PubMed  Google Scholar 

  15. Neuropathology group of the medical research council cognitive function and ageing study (MRC-CFAS). Pathological correlates of late-onset dementia in a multicentre community-based population in England and Wales. Lancet. 2001;357:169–75.

    Article  Google Scholar 

  16. Tanskanen M, Lindsberg PJ, TIenari PJ, et al. Cerebral amyloid agniopathy in a 95+ cohort: complement activation and apolipoprotein E (APoE) genotype. Neuropathol Appl Neurobiol. 2005;31:589–99.

    Article  CAS  PubMed  Google Scholar 

  17. Ringman JM, Sachs MC, Zhou Y, Saver J, Vinters HV. Clinical predictors of severe cerebral amyloid angiopathy and influence of APOE genotype in persons with pathologically verified Alzheimer disease. JAMA Neurol. 2014;71:878–83.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Apoil M, Cogez J, Duboc L, et al. Focal cortical subarachnoid hemorrhage revealed by recurrent paresthesias: a clinico-radiological syndrome strongly associated with cerebral amyloid angiopathy. Cerebrovasc Dis. 2013;36:139–44.

    Article  PubMed  Google Scholar 

  19. Charidimou A, Peeters A, Fox Z, et al. Spectrum of transient focal neurological episodes in cerebral amyloid angiopathy: multicentre magnetic resonance imaging cohort study and meta-analysis. Stroke. 2012;43:2324–30.

    Article  PubMed  Google Scholar 

  20. Charidimou A, Peeters A, Jager R, et al. Cortical superficial siderosis and intracerebral hemorrhage risk in cerebral amyloid angiopathy. Neurology. 2013;81:1666–73.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Greenberg S, Eng J, Ming M, Smith E, Rosand J. Hemorrhage burden predits recurrent intracerebral hemorrhage after lobar hemorrhage. Stroke. 2004;35:1415–20.

    Article  PubMed  Google Scholar 

  22. Oide T, Takahashi H, Yutani C, Ishihara T, Ikeda S. Relationship between lobar intracerebral hemorrhage and leukoencephalopathy associated with cerebral amyloid angiopathy: clinicopathological study of 64 Japanese patients. Amyloid. 2003;10:136–43.

    Article  PubMed  Google Scholar 

  23. Rannikmae K, Samarasekera N, Martinez Gonzalez NA, Al-Shahi Halman R, Sudlow CL. Genetics of cerebral amyloid angiopathy: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2013;84:901–8.

    Article  PubMed  Google Scholar 

  24. Aryanitakis Z, Leurgans SE, Wang Z, Wilson RS, Bennett DA, Schneider JA. Cerebral amyloid angiopathy pathology and cognitive domains in older persons. Ann Neurol. 2011;69:320–7.

    Article  Google Scholar 

  25. Kennedy K, Raz N. Aging white matter and cognition: differential effects of regional variations in diffusion properties on memory, executive functions, and speed. Neuropsychologia. 2009;47:916–27.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Holland C, Smith E, Csapo I, et al. Spatial distribution of white-matter hyperintensities in Alzheimer disease, cerebral amyloid angiopathy and healthy aging. Stroke. 2008;39:1127–33.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gregg N, Kim A, Gurol M, et al. Incidental cerebral microbleeds and cerebral blood flow in elderly individuals. JAMA Neurol. 2015;72(9):1021–8.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Dumas A, Dierksen G, Gurol ME, et al. Functional magnetic resonance imaging detection of vascular reactivity in cerebral amyloid angiopathy. Ann Neurol. 2012;72:76–81.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Gray F, Dubas F, Roullet E, Escourolle R. Leukoencephalopathy in diffuse hemorrhagic cerebral amyloid angiopathy. Ann Neurol. 1985;18:54–9.

    Article  CAS  PubMed  Google Scholar 

  30. Soontornniyomkij V, Lynch M, Mermash S, et al. Cerebral microinfarcts associated with severe cerebral beta-amyloid angiopathy. Brain Pathol. 2010;20:459–67.

    Article  PubMed  Google Scholar 

  31. Olichney JM, Hansen LA, Hofstetter CR, Lee JH, Katzman R, Thal LJ. Association between severe cerebral amyloid angiopathy and cerebrovascular lesions in Alzheimer disease in not a spurious one attributable to apolipoprotein E4. Arch Neurol. 2000;57:869–74.

    Article  CAS  PubMed  Google Scholar 

  32. Schneider J, Boyle P, Arvanitakis Z, Bienias J, Bennett D. Subcortical infarcts, Alzheimer’s disease pathology, and memory function in older persons. Ann Neurol. 2007;62:59–66.

    Article  PubMed  Google Scholar 

  33. Kovari E, Gold G, Hermann F, et al. Cortical microinfarcts and demyelination affect cognition in cases at high risk for dementia. Neurology. 2007;68:927–31.

    Article  CAS  PubMed  Google Scholar 

  34. Chui H, Zarrow C, Marck W, et al. Cognitive impact of subcortical vascular and Alzheimer’s disease pathology. Ann Neurol. 2006;60:677–87.

    Article  PubMed  PubMed Central  Google Scholar 

  35. McAuley G, Schrag M, Barnes S, et al. Iron quantification of microbleeds in postmortem brain. Magn Reson Med. 2011;65:1592–601.

    Article  CAS  PubMed  Google Scholar 

  36. Schrag M, Greer D. Clinical associations of microbleeds on magnetic resonance neuroimaging. J Stroke Cerebrovasc Dis. 2014;23:2489–97.

    Article  PubMed  Google Scholar 

  37. Kirsch W, McAuley G, Holshouser B, et al. Serial susceptibility weighted MRI measures brain iron and microbleeds in dementia. J Alzheimers Dis. 2009;17:599–609. This study found that patients with cortical/lobar microhemorrhages and mild cognitive impairment were more likely to develop dementia and those without microhemorrhages.

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Chiang G, Cruz Hernandez J, Kantarci K, Jack C, Weiner M. Cerebral microbleeds, CSF p-Tau and cognitive decline: significance of anatomic distribution. AJNR Am J Neuroradiol. 2015;36:1635–41. This study demonstrated that the location of microhemorrhages were important in determining their impact on cognition – cortical/lobar microhemorrhages predict poor cognitive performance while deep microhemorrhages have less impact on cognition.

    Article  CAS  PubMed  Google Scholar 

  39. Poels M, Ikram M, van der Lugt A, et al. Cerebral microbleeds are associated with worse cognitive function: the Rotterdam scan study. Neurology. 2012;12:326–33. This study confirmed the association of cortical/lobar microhemorrhages with cognitive dysfunction on a population level.

    Article  Google Scholar 

  40. van der Vlies AE, Goos JD, Barkhof F, Scheltens P, ven der Flier WM. Microbleeds do not affect rate of cognitive decline in Alzheimer disease. Neurology. 2012;79:763–9.

    Article  PubMed  Google Scholar 

  41. Kinnecom C, Lev M, Wendell L, et al. Course of cerebral amyloid angiopathy-related inflammation. Neurology. 2007;68:1411–6.

    Article  CAS  PubMed  Google Scholar 

  42. Kirshner HS, Bradshaw MJ. The inflammatory form of cerebral amyloid angiopathy or “cerebral amyloid angiopathy-related inflammation” (CAARI). Curr Neurol Neurosci Rep Bug. 2015;15:54.

    Article  Google Scholar 

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Correspondence to Howard Kirshner.

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Matthew Schrag and Howard Kirshner declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Behavior

*A special thank you to Dr. John Brust for taking the time to review this article.

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Schrag, M., Kirshner, H. Neuropsychological Effects of Cerebral Amyloid Angiopathy. Curr Neurol Neurosci Rep 16, 76 (2016). https://doi.org/10.1007/s11910-016-0674-1

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