A retrospective cohort study of 11 patients with iatrogenic CAA (iCAA; mean age 42 ± 8.3 years) evaluated whether progressive neurodegeneration and cognitive impairment develop over time, using serial brain MRI atrophy scores (MTA, Koedam, GCA) and formal neuropsychometry over a median 5-year follow-up.
Over a median 5-year follow-up, 8/11 (73%) developed new brain atrophy on at least one MRI score (moderate-to-severe in 3 patients); 9/11 (82%) had cognitive impairment at a median 3-year follow-up (7 minor, 2 major disorders); AD neuropathological change was histopathologically confirmed in 2/4 (50%) examined cases. No patient showed atrophy or reported cognitive concerns at baseline.
- Very small cohort (n = 11) from a single quaternary referral center, limiting generalizability. - Retrospective design with variable investigations across patients (e.g., CSF tau assessed in only 3, biopsy in 4). - Standard CSF/PET amyloid biomarkers cannot reliably distinguish CAA from AD, and plasma p-tau217 was not systematically used.
Patients with iCAA — even those presenting young with hemorrhage and no baseline cognitive complaints — frequently develop progressive atrophy and cognitive deficits; routine neuropsychometry and neurodegenerative biomarker assessment (including tau markers) should be part of their follow-up care. Clinicians should maintain vigilance for early cognitive decline in this population to enable timely management.
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