Photo Credit: Artur Plawgo

The following is a summary of “Cerebral Amyloid Angiopathy, Dementia, and Alzheimer Neuropathologic Changes: Findings From the ACT Autopsy Cohort,” published in the October 2024 issue of Neurology by Sin et al.     

Among older adults’ cerebral amyloid angiopathy (CAA) is prevalent and is linked to dementia. However, the extent to which this relationship is influenced by Alzheimer’s disease (AD) neuropathologic changes remains unclear.   

Researchers conducted a retrospective study examining the relationship between CAA and dementia, considering AD neuropathology.   

They analyzed the Kaiser Permanente Washington database from the Adult Changes in Thought (ACT) autopsy cohort, assessing 848 participants (mean age 86.7 ± 4.6 years; 57.6% female) for CAA, dementia, amyloid neuritic plaques (Consortium to Establish a Registry for Alzheimer’s Disease [CERAD]), and tau neurofibrillary tangles (Braak stages). Multivariable logistic regression models estimated ORs and 95% CIs for associations of CAA with dementia, adjusting for age at death, sex, and additional factors, separately for CERAD scores (moderate-severe vs. mild-absent) and Braak stages (V–VI vs. 0–IV).   

The results showed that dementia was more prevalent among those with CAA than those without (53.7% vs. 40.1%; age-sex–adjusted OR 1.57, 95% CI 1.18–2.10). The association remained significant after adjusting for other covariates but lost significance when adjusted for CERAD scores (OR 1.27, 95% CI 0.93–1.71) and Braak stages (OR 0.96, 95% CI 0.69–1.33). Findings from the mediation analyses indicated that the ORs for natural indirect effects (NIEs) of CERAD scores and Braak stages were 1.25 (1.13–1.37) and 1.63 (1.38–1.88), respectively, with CERAD scores and Braak stages mediating 53% and 111% of the total association.   

They concluded that the relationship between CAA and dementia may be mediated by AD neuropathologic changes, highlighting the need for further mechanistic studies in AD.   

Source: neurology.org/doi/10.1212/WNL.0000000000210009