Cognitive Impairment Before Intracerebral Hemorrhage Is Associated With Cerebral Amyloid Angiopathy
Authors: Banerjee Gargi , Wilson Duncan , Ambler Gareth , Osei-Bonsu Appiah Karen , Shakeshaft Clare , Lunawat Surabhika , Cohen Hannah , Yousry Tarek , Lip Gregory Y.H. , Muir Keith W. , Brown Martin M. , Al-Shahi Salman Rustam , Jäger Hans Rolf , Werring David J. , Shaw Louise , Sword Jane , Mohd Nor Azlisham , Sharma Pankaj , Veltkamp Roland , Kelly Deborah , Harrington Frances , Randall Marc , Smith Matthew , Mahawish Karim , Elmarim Abduelbaset , Esisi Bernard , Cullen Claire , Nallasivam Arumug , Price Christopher , Barry Adrian , Roffe Christine , Coyle John , Hassan Ahamad , Lovelock Caroline , Birns Jonathan , Cohen David , Sekaran L. , Parry-Jones Adrian , Parry Anthea , Hargroves David , Proschel Harald , Datta Prabel , Darawil Khaled , Manoj Aravindakshan , Burn Mathew , Patterson Chris , Giallombardo Elio , Smyth Nigel , Mansoor Syed , Anwar Ijaz , Marsh Rachel , Ispoglou Sissi , Chadha Dinesh , Prabhakaran Mathuri , Meenakishundaram Sanjeevikumar , O’Connell Janice , Scott Jon , Krishnamurthy Vinodh , Aghoram Prasanna , McCormick Michael , O’Mahony Paul , Cooper Martin , Choy Lillian , Wilkinson Peter , Leach Simon , Caine Sarah , Burger Ilse , Gunathilagan Gunaratam , Guyler Paul , Emsley Hedley , Davis Michelle , Manawadu Dulka , Pasco Kath , Mamun Maam , Luder Robert , Sajid Mahmud , Anwar Ijaz , Okwera James , Staals Julie , Warburton Elizabeth , Saastamoinen Kari , England Timothy , Putterill Janet , Flossman Enrico , Power Michael , Dani Krishna , Mangion David , Suman Appu , Corrigan John , Lawrence Enas , Vahidassr Djamil 
Published: December 2017

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:
https://www.clinicaltrials.gov
. Unique identifier: NCT02513316.