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. 2023 Dec;270(12):6124-6132.
doi: 10.1007/s00415-023-11977-8. Epub 2023 Sep 6.

Domain-specific neuropsychological investigation of CAA with and without intracerebral haemorrhage

Edgar Chan  1   2 , Guendalina B Bonifacio  3 , Corin Harrison  4 , Gargi Banerjee  3 , Jonathan G Best  3 , Benjamin Sacks  5 , Nicola Harding  5 , Maria Del Rocio Hidalgo Mas  4   3 , H Rolf Jäger  6 , Lisa Cipolotti  4   3 , David J Werring  3
Affiliations

Domain-specific neuropsychological investigation of CAA with and without intracerebral haemorrhage

Edgar Chan et al. J Neurol. 2023 Dec.

Abstract

Background: Cerebral amyloid angiopathy (CAA) is associated with cognitive impairment, but the contributions of lobar intracerebral haemorrhage (ICH), underlying diffuse vasculopathy, and neurodegeneration, remain uncertain. We investigated the domain-specific neuropsychological profile of CAA with and without ICH, and their associations with structural neuroimaging features.

Methods: Data were collected from patients with possible or probable CAA attending a specialist outpatient clinic. Patients completed standardised neuropsychological assessment covering seven domains. MRI scans were scored for markers of cerebral small vessel disease and neurodegeneration. Patients were grouped into those with and without a macro-haemorrhage (CAA-ICH and CAA-non-ICH).

Results: We included 77 participants (mean age 72, 65% male). 26/32 (81%) CAA-non-ICH patients and 41/45 (91%) CAA-ICH patients were impaired in at least one cognitive domain. Verbal IQ and non-verbal IQ were the most frequently impaired, followed by executive functions and processing speed. We found no significant differences in the frequency of impairment across domains between the two groups. Medial temporal atrophy was the imaging feature most consistently associated with cognitive impairment (both overall and in individual domains) in both univariable and multivariable analyses.

Discussion: Cognitive impairment is common in CAA, even in the absence of ICH, suggesting a key role for diffuse processes related to small vessel disease and/or neurodegeneration. Our findings indicate that neurodegeneration, possibly due to co-existing Alzheimer's disease pathology, may be the most important contributor. The observation that general intelligence is the most frequently affected domain suggests that CAA has a generalised rather than focal cognitive impact.

Keywords: Cerebral amyloid angiopathy; Cognition; Dementia; Neuropsychology; Stroke.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Comparison of the proportion of patients impaired in each domain split by non-ICH and ICH groups. Concentric lines represent increasing degree of impairment in 10% increments with outermost line representing 70%
See this image and copyright information in PMC

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