Sporadic cerebral amyloid angiopathy (CAA) is a disorder of the elderly in which A beta deposition in the cortical and leptomeningeal arteries leads to vessel fragility and rupture. The most devastating complication of CAA is lobar intracerebral hemorrhage (ICH), which has a high rate of recurrence. Patients with CAA also have a high prevalence of dementia, partly due to coexisting Alzheimer's disease but also possibly due to brain ischemia. Leukoaraiosis (LA), changes in the cerebral white matter due to chronic ischemia, is known to occur in CAA but the prevalence has never before been investigated. It is unknown whether LA predicts the development of recurrent brain hemorrhage or dementia in CAA patients. Therefore, the following hypotheses will be tested using a prospective cohort design: 1) That LA in CAA patients is associated with an increased risk of pre-ICH dementia, and confers an increased risk of the development of post-ICH dementia, 2) that an increased amount of baseline LA confers an increased risk of recurrent ICH, and 3) that LA progression is associated with the development of dementia and decreased cognitive function. Patients will be recruited from a multi-center NIH-funded clinical trial for the prevention of recurrent lobar ICH, as well as a consecutive database of lobar ICH patients admitted to Massachusetts General Hospital. The amount of LA will be determined at baseline on CT and MRI using modifications of widely used rating scales, and the patients will be followed closely for the outcomes of interest. MRI will be repeated at 8, 16, and 36 months. As part of the Award, the principal investigator will complete formal training in research ethics, biostatistics and epidemiology, and develop further expertise with radiological tools for the investigation of white matter vascular pathology. By completion, he will have obtained the necessary skills to function as an independent investigator with expertise in hemorrhagic cerebrovascular disease and white matter neuroimaging.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23NS046327-02
Application #
6799180
Study Section
NST-2 Subcommittee (NST)
Program Officer
Leblanc, Gabrielle G
Project Start
2003-09-15
Project End
2008-07-31
Budget Start
2004-08-01
Budget End
2005-07-31
Support Year
2
Fiscal Year
2004
Total Cost
$170,586
Indirect Cost
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02199
Smith, Eric E; Nandigam, Kaveer R N; Chen, Yu-Wei et al. (2010) MRI markers of small vessel disease in lobar and deep hemispheric intracerebral hemorrhage. Stroke 41:1933-8
Biffi, A; Halpin, A; Towfighi, A et al. (2010) Aspirin and recurrent intracerebral hemorrhage in cerebral amyloid angiopathy. Neurology 75:693-8
Viswanathan, A; Raj, S; Greenberg, S M et al. (2009) Plasma Abeta, homocysteine, and cognition: the Vitamin Intervention for Stroke Prevention (VISP) trial. Neurology 72:268-72
Smith, Eric E; Greenberg, Steven M (2009) Beta-amyloid, blood vessels, and brain function. Stroke 40:2601-6
Smith, E E; Vijayappa, M; Lima, F et al. (2008) Impaired visual evoked flow velocity response in cerebral amyloid angiopathy. Neurology 71:1424-30
Viswanathan, Anand; Patel, Pratik; Rahman, Rosanna et al. (2008) Tissue microstructural changes are independently associated with cognitive impairment in cerebral amyloid angiopathy. Stroke 39:1988-92
Smith, Eric E; Dreyer, Paul; Prvu-Bettger, Janet et al. (2008) Stroke center designation can be achieved by small hospitals: the Massachusetts experience. Crit Pathw Cardiol 7:173-7
FitzMaurice, Emilie; Wendell, Lauren; Snider, Ryan et al. (2008) Effect of statins on intracerebral hemorrhage outcome and recurrence. Stroke 39:2151-4
Smith, Eric E; Abdullah, Abdul R; Amirfarzan, Houman et al. (2007) Serum lipid profile on admission for ischemic stroke: failure to meet National Cholesterol Education Program Adult Treatment Panel (NCEP-ATPIII) guidelines. Neurology 68:660-5
Nandigam, R N Kaveer; Chen, Yu-Wei; Gurol, Mahmut E et al. (2007) Validation of intracranial area as a surrogate measure of intracranial volume when using clinical MRI. J Neuroimaging 17:74-7

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