What is the prognosis of cerebral amyloid angiopathy (CAA) with dementia?

Updated: Dec 19, 2018
  • Author: Ravi S Menon, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Cognitive impairment is a common feature of CAA. CAA is the most significant microscopic abnormality in 10-15% of patients diagnosed with Alzheimer disease (AD) by clinical criteria. More than 40% of patients with ICH have some degree of dementia. In some cases, the cognitive changes precede the ICH.

The relationship between CAA and AD is close. CAA, present in 80-85% of patients with AD, is severe in one third to two thirds of these patients.

Vascular lesions can play a significant pathophysiologic role and can contribute to the development of dementia in AD. The severity of CAA is correlated with the presence of ischemic or hemorrhagic lesions in the brains of patients with AD, and CAA is associated with gross strokes but not with subcortical lacunae.

Although CAA may contribute to the neurodegeneration of AD, a direct causal link between the 2 disorders has not been established. The association could be due to shared risk factors, such as the presence of APOE gene’s e4 allele.

Some patients with CAA present with a progressive dementia, involving rapid cognitive decline over days or weeks. This rapid progression could be due to the additive effects of severe vascular amyloid, cortical hemorrhages and infarctions, white matter destruction, and accumulation of neuritic plaques.

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