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Abstract
Background: Cerebral microbleeds (MBs) are commonly observed in memory clinic patients. Little is known about occurrence of and risk factors for developing new MBs in this population.
Objective: To investigate incidence of lobar and nonlobar MBs in a memory clinic population. Furthermore, to assess risk factors for the development of new MBs and their associations with other MRI changes.
Methods: A total of 254 patients visiting our memory clinic, with repeat gradient-recalled echo T2*-weighted MRI, were included (scan interval 1.9 ± 0.9 years). Baseline and incident MBs were regionally counted. White matter hyperintensities (WMH) and progression of WMH were assessed using visual rating scales. Baseline brain volume and whole-brain atrophy rate were estimated automatically. In a subset, APOE was determined.
Results: Thirty-one (12%) patients developed new MBs (range 1–19). Both multiple strictly lobar and nonlobar MBs at baseline predicted incident MBs (odds ratio [OR] 8.4; 95% confidence interval [CI] 2.2–33.2, and OR 33.8; 95% CI 8.1–140.8). Furthermore, baseline WMH grade (OR 1.2; 1.1–1.3), lacunar infarcts (OR 2.8; 1.3–6.0), and APOE ε2 carriership (OR 4.2; 1.4–12.5) predicted MB incidence. Incident MB patients had more progression of WMH (p < 0.01) and incident lacunar infarcts (p < 0.05). These relations were most prominent for incident nonlobar MBs. Incident strictly lobar MBs were associated with smoking.
Conclusion: In addition to APOE genotype, presence and progression of small-vessel disease and vascular risk factors were predictors of new MBs. The latter are potentially modifiable, suggesting the possibility of preventing incident MBs, hopefully resulting in slower clinical decline.
Glossary
- AD=
- Alzheimer disease;
- ARWMC=
- Age-Related White Matter Change scale;
- CAA=
- cerebral amyloid angiopathy;
- CADASIL=
- cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy;
- CI=
- confidence interval;
- GRE=
- gradient-recalled echo;
- MB=
- microbleed;
- MCI=
- mild cognitive impairment;
- MMSE=
- Mini-Mental State Examination;
- OR=
- odds ratio;
- WMH=
- white matter hyperintensity.
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