• Emma A Koemans, Jasmeer P Chhatwal, Susanne J van Veluw, Ellis S van Etten, van OschMatthias J PMJPDepartment of Neurology and Department of Radiology, Leiden University Medical Center, Leiden, Netherlands., van WalderveenMarianne A AMAADepartment of Neurology and Department of Radiology, Leiden University Medical Center, Leiden, Netherlands., Hamid R Sohrabi, Mariel G Kozberg, Zahra Shirzadi, Gisela M Terwindt, Mark A van Buchem, Eric E Smith, David J Werring, Ralph N Martins, WermerMarieke J HMJHDepartment of Neurology and Department of Radiology, Leiden University Medical Center, Leiden, Netherlands., and Steven M Greenberg.
• Department of Neurology and Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.
• Lancet Neurol. 2023 Jul 1; 22 (7): 632642632-642.

AbstractCerebral amyloid angiopathy, which is defined by cerebrovascular deposition of amyloid β, is a common age-related small vessel pathology associated with intracerebral haemorrhage and cognitive impairment. Based on complementary lines of evidence from in vivo studies of individuals with hereditary, sporadic, and iatrogenic forms of cerebral amyloid angiopathy, histopathological analyses of affected brains, and experimental studies in transgenic mouse models, we present a framework and timeline for the progression of cerebral amyloid angiopathy from subclinical pathology to the clinical manifestation of the disease. Key stages that appear to evolve sequentially over two to three decades are (stage one) initial vascular amyloid deposition, (stage two) alteration of cerebrovascular physiology, (stage three) non-haemorrhagic brain injury, and (stage four) appearance of haemorrhagic brain lesions. This timeline of stages and the mechanistic processes that link them have substantial implications for identifying disease-modifying interventions for cerebral amyloid angiopathy and potentially for other cerebral small vessel diseases.Copyright © 2023 Elsevier Ltd. All rights reserved.

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