Abstract T MP111: Cerebral Amyloid Angiopathy Is Associated With Arteriolar Sclerosis And Microinfarcts, But Not Overt Ischemic Stroke Or Hemorrhage In A Large Autopsy Series

Abstract

Introduction: Cerebral amyloid angiopathy (CAA) has been associated with various types of cerebrovascular pathology independent of Alzheimer’s disease (AD), including atherosclerosis, arteriosclerosis, ischemic and hemorrhagic infarction. Available studies have frequently produced conflicting results in regards to specific cerebrovascular associations, likely due to confounds of subject selection biases, small sample sizes, and incomplete pathologic analyses. The present study represents one of the largest and most comprehensive clinical-pathologic series to date focused on examining clinical, genetic, and pathologic associations in CAA. Hypothesis: As CAA represents a vasculopathy of the small arterioles and capillaries, we hypothesized that cerebrovascular associations with CAA would include small vessel pathologies and microinfarcts rather than large or medium vessel pathologies. Methods: Cases were derived from the University of Kentucky brain bank (n=741). Vascular pathology was graded on semiquantitative scale or as present/absent. Cases were grouped by presence (n=414) or absence of CAA (n=327). Standard descriptive and comparative statistics were used for the analysis. Results: ApoE status (p<0.001), but not age, was associated with CAA. Cases with and without CAA did not differ in regards to large vessel or lacunar ischemic stroke, hemorrhagic stroke, hippocampal sclerosis, or circle of Willis atherosclerosis. A significant increase in arteriolar sclerosis (p<0.001) and microinfarct burden (p<0.01) was seen in the CAA-positive group. Conclusions: CAA across the cognitive continuum, appears independent of age, and is a significant contributor to small vessel ischemic changes that may have a profound effect on brain health, including risk for stroke and cognitive impairment. Comprehensive treatment strategies for small vessel ischemic disease need to acknowledge and potentially address the role of CAA as therapeutic treatments for this unique vasculopathy become available in the future.