• Jae-Hyun Park, Sang Won Seo, Changsoo Kim, Geon Ha Kim, Hyun Jin Noh, Sung Tae Kim, Ki-Chang Kwak, Uicheul Yoon, Jong Min Lee, Jong Weon Lee, Ji Soo Shin, Chi Hun Kim, Young Noh, Hanna Cho, Hee Jin Kim, Cindy W Yoon, Seung Jun Oh, Jae Seung Kim, Yearn Seong Choe, Kyung-Han Lee, Jae-Hong Lee, Michael Ewers, Michael W Weiner, David J Werring, and Duk L Na.
• Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
• Ann. Neurol. 2013 May 1;73(5):584-93.

ObjectiveCerebral microbleeds (CMBs) are a neuroimaging marker of small vessel disease (SVD) with relevance for understanding disease mechanisms in cerebrovascular disease, cognitive impairment, and normal aging. It is hypothesized that lobar CMBs are due to cerebral amyloid angiopathy (CAA) and deep CMBs are due to subcortical ischemic SVD. We tested this hypothesis using structural magnetic resonance imaging (MRI) markers of subcortical SVD and in vivo imaging of amyloid in patients with cognitive impairment.MethodsWe included 226 patients: 89 with Alzheimer disease-related cognitive impairment (ADCI) and 137 with subcortical vascular cognitive impairment (SVCI). All subjects underwent amyloid imaging with [(11) C] Pittsburgh compound B (PiB) positron emission tomography, and MRI to detect CMBs and markers of subcortical SVD, including the volume of white matter hyperintensities (WMH) and the number of lacunes.ResultsParietal and occipital lobar CMBs counts were higher in PiB(+) ADCI with moderate WMH than PiB(+) ADCI with minimal WMH, whereas PiB(-) patients with SVCI (ie, "pure" SVCI) showed both lobar and deep CMBs. In multivariate analyses of the whole cohort, WMH volume and lacuna counts were positively associated with both lobar and deep CMBs, whereas amyloid burden (PiB) was only associated with lobar CMBs. There was an interaction between lacuna burden and PiB retention on lobar (but not deep) CMBs (p<0.001).InterpretationOur findings suggest that although deep CMBs are mainly linked to subcortical SVD, both subcortical SVD and amyloid-related pathologies (eg, CAA) contribute to the pathogenesis of lobar CMBs, at least in subjects with mixed lobar and deep CMBs. Furthermore, subcortical SVD and amyloid-related pathologies interact to increase the risk of lobar CMBs.Copyright © 2012 American Neurological Association.

27 keywords...

hide…