Cerebral Amyloid Angiopathy in Alzheimer Disease: A Comparison Between Different Versions of the Boston Criteria

Abstract

Objectives: Cerebral amyloid angiopathy (CAA) is the main driver of amyloid-related imaging abnormalities (ARIAs) in Alzheimer disease (AD). We compared different versions of the Boston criteria for CAA diagnosis in AD.

Methods: This article presents a single-center analysis (outpatient neurodegenerative clinic) of patients with AD with mild cognitive impairment (MCI) or early dementia, meeting NIA-AA criteria and having biological amyloid confirmation (CSF or imaging). Two raters analyzed hemorrhagic (cerebral microbleeds, CMBs; cortical superficial siderosis, cSS) and nonhemorrhagic (severe centrum semiovale perivascular spaces, CSO-PVSs; multispot pattern white matter hyperintensities (WMHs)) markers following the original (V1.0), modified (V1.5), and latest (V2.0) Boston criteria.

Results: We included 75 patients (mean age 71.6 ± 8.1 years, 53% female, mean disease duration 2.6 ± 2.0 years, 91% MCI). White matter CAA markers were more common than hemorrhagic markers: 41 (55%) had severe CSO-PVSs, 28 (37%) had multispot WHMs, 12 (16%) had 1 lobar CMB, 9 had ≥2 lobar CMBs (12%), 1 (1.3%) had focal cSS, and 5 (6.7) had disseminated cSS. The prevalence of possible and probable CAA was lowest with V1.0 (14.7% and 9.3%) than with V1.5 (13.3% and 13.3%) and V2.0 (42.7% and 26.7%) criteria.

Discussion: More than 1 in 4 patients with AD had probable CAA according to the V2.0 Boston criteria. These findings might inform future trials.