Cerebral Microbleeds Are Predictive of Mortality in the Elderly

Department of Radiology, C2-S, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
Stroke (Impact Factor: 5.72). 03/2011; 42(3):638-44. DOI: 10.1161/STROKEAHA.110.595611
Source: PubMed


To investigate the prognostic value of cerebral microbleeds (CMB) regarding overall, cardiovascular-related, and stroke-related mortality and to investigate possible differences based on a cerebral amyloid angiopathy-type and nonlobar distribution of microbleeds.
We included 435 subjects who were participants from the nested MRI substudy of the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). Cox proportional hazard models were applied to estimate the risk of overall, cardiovascular-related, and stroke-related death associated with microbleeds in general and microbleeds with a lobar distribution suggestive of the presence of cerebral amyloid angiopathy. The corresponding Kaplan-Meier survival curves were calculated.
Subjects with >1 CMB had a 6-fold risk of stroke-related death compared to subjects without CMB (hazard ratio, 5.97; 95% CI, 1.60-22.26; P=0.01). The diagnosis of nonlobar microbleeds was associated with >2-fold risk of cardiovascular death compared to subjects without microbleeds (hazard ratio, 2.67; 95% CI, 1.23-5.81; P=0.01). Subjects with probable cerebral amyloid angiopathy-type microbleeds had >7-fold risk of stroke-related death compared to subjects without CMB (hazard ratio, 7.20; 95% CI, 1.44-36.10; P=0.02).
This is the first study investigating the association between microbleeds and risk of overall, cardiovascular-related, and stroke-related mortality in an elderly population. Our findings indicate that the diagnosis of microbleeds is potentially of clinical relevance. Larger studies are needed to expand our observations and to address potential clinical implications and cost-benefits of such a policy.

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Available from: Stella Trompet, Jan 22, 2014
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    • "Mortality was also strongly predicted by MBs (especially when multiple) in another study following patients in a large memory clinic cohort [39]. When specific causes of death according to MB distribution were investigated in a population-based cohort of older people at high risk of cardiovascular disease, deep MBs were associated with cardiovascular mortality, whereas lobar MBs were associated with stroke-related mortality [40]. These findings fit well with the notion of lobar and deep MBs associated with HV and CAA, respectively. "
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    ABSTRACT: Cerebral microbleeds (MBs) are small chronic brain hemorrhages which are likely caused by structural abnormalities of the small vessels of the brain. Owing to the paramagnetic properties of blood degradation products, MBs can be detected in vivo by using specific magnetic resonance imaging (MRI) sequences. Over the last decades, the implementation of these MRI sequences in both epidemiological and clinical studies has revealed MBs as a common finding in many different populations, including healthy individuals. Also, the topographic distribution of these MBs has been shown to be potentially associated with specific underlying vasculopathies. However, the clinical and prognostic significance of these small hemorrhages is still a matter of debate as well as a focus of extensive research. In this article, we aim to review the current knowledge on the pathophysiology and clinical implications of MBs, with special emphasis on the links between lobar MBs, cerebral amyloid angiopathy, and Alzheimer’s disease.
    Alzheimer's Research and Therapy 06/2014; 6(33). DOI:10.1186/alzrt263 · 3.98 Impact Factor
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    • "We found a clearly higher prevalence of microbleeds in patients with AD, probably due to concomitant cerebral amyloid angiopathy [31]. Their clinical relevance was not clear, but we and others showed them to be related to higher risk of mortality , though inconsistently to impaired cognition [32] [67] [68]. The most important risk factor for developing a microbleed was having microbleeds at baseline [69]. "
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    ABSTRACT: Since its opening in 2000, patient care and research go hand in hand at the Alzheimer center of the VU University Medical Center, both organized in such a way that they mutually strengthen each other. Our mission is to give patients a voice by lifting the stigma on dementia, to find new diagnostic and treatment strategies, and, ultimately, to cure diseases that cause dementia. Our healthcare pathway is uniquely designed to accommodate all necessary investigations for the diagnostic work-up of dementia in one day (one-stop shop). A second unique feature is that research has been fully integrated in the healthcare pathway. The resulting Amsterdam Dementia Cohort now includes over 4000 patients, and for the majority of these, we have MRI, EEG, blood (serum, plasma), DNA, and CSF available. The Amsterdam Dementia Cohort forms the basis of much of our research, which focuses on four major research lines: 1) variability in manifestation, 2) early diagnosis, 3) vascular factors, and 4) interventions. By answering research questions closely related to clinical practice, the results of our research can be looped back to improve clinical work-up for our patients.
    Journal of Alzheimer's disease: JAD 03/2014; 41(1). DOI:10.3233/JAD-132306 · 4.15 Impact Factor
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    ABSTRACT: Microbloedingen zijn kleine ronde laesies (<10mm), zichtbaar als hypo-intense (zwarte) signalen op T2*-gewogen MRI-sequenties (Greenberg et al., 2009). Deze technieken zijn gevoelig voor lokale verstoring van het magnetische veld, bijvoorbeeld door ijzerhoudende materialen. De radiologische afwijkingen corresponderen met specifieke onderliggende pathologische afwijkingen, te weten ophopingen van het bloedafbraakproduct hemosiderine, langs de kleine hersenvaten (Greenberg et al., 2009; Fazekas et al., 1999).
    10/2011; 15(5):134-137. DOI:10.1007/s12474-011-0025-6
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