Cognitive Impairment Before Intracerebral Hemorrhage Is Associated With Cerebral Amyloid Angiopathy

Stroke. 2018 Jan;49(1):40-45. doi: 10.1161/STROKEAHA.117.019409. Epub 2017 Dec 15.


Background and purpose: Although the association between cerebral amyloid angiopathy (CAA) and cognitive impairment is increasingly recognized, it is not clear whether this is because of the impact of recurrent intracerebral hemorrhage (ICH) events, disruptions caused by cerebral small vessel damage, or both. We investigated this by considering whether cognitive impairment before ICH was associated with neuroimaging features of CAA on magnetic resonance imaging.

Methods: We studied 166 patients with neuroimaging-confirmed ICH recruited to a prospective multicentre observational study. Preexisting cognitive impairment was determined using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Magnetic resonance imaging markers of cerebral small vessel disease, including CAA, were rated by trained observers according to consensus guidelines.

Results: The prevalence of cognitive impairment before ICH was 24.7% (n=41) and, in adjusted analyses, was associated with fulfilling the modified Boston criteria for probable CAA at presentation (odds ratio, 4.01; 95% confidence interval, 1.53-10.51; P=0.005) and a higher composite CAA score (for each point increase, odds ratio, 1.42; 95% confidence interval, 1.03-1.97; P=0.033). We also found independent associations between pre-ICH cognitive decline and the presence of cortical superficial siderosis, strictly lobar microbleeds, and lobar ICH location, but not with other neuroimaging markers, or a composite small vessel disease score.

Conclusions: CAA (defined using magnetic resonance imaging markers) is associated with cognitive decline before symptomatic ICH. This provides evidence that small vessel disruption in CAA makes an independent contribution to cognitive impairment, in addition to effects due to brain injury caused directly by ICH.

Clinical trial registration: URL: Unique identifier: NCT02513316.

Keywords: cerebral amyloid angiopathy; cerebral hemorrhage; cerebral small vessel diseases; cognitive dysfunction; prevalence; siderosis.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cerebral Amyloid Angiopathy* / complications
  • Cerebral Amyloid Angiopathy* / diagnostic imaging
  • Cerebral Amyloid Angiopathy* / physiopathology
  • Cerebral Hemorrhage* / diagnostic imaging
  • Cerebral Hemorrhage* / etiology
  • Cerebral Hemorrhage* / physiopathology
  • Cognitive Dysfunction* / complications
  • Cognitive Dysfunction* / diagnostic imaging
  • Cognitive Dysfunction* / physiopathology
  • Female
  • Humans
  • Magnetic Resonance Angiography*
  • Male
  • Middle Aged
  • Neuroimaging*

Associated data