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The increasing impact of cerebral amyloid angiopathy: essential new insights for clinical practice.

  • Banerjee, Gargi1
  • Carare, Roxana2
  • Cordonnier, Charlotte3
  • Greenberg, Steven M4
  • Schneider, Julie A5
  • Smith, Eric E6
  • Buchem, Mark van7
  • Grond, Jeroen van der7
  • Verbeek, Marcel M8, 9
  • Werring, David J1
  • 1 Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK.
  • 2 Division of Clinical Neurosciences, Faculty of Medicine, University of Southampton, Southampton, UK.
  • 3 Department of Neurology, Université de Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, Centre Hospitalier Régional Universitaire de Lille, Lille, France. , (France)
  • 4 J P Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • 5 Departments of Pathology and Neurological Sciences, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
  • 6 Hotchkiss Brain Institute, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada. , (Canada)
  • 7 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. , (Netherlands)
  • 8 Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands. , (Netherlands)
  • 9 Departments of Neurology and Laboratory Medicine, Radboud Alzheimer Center, Nijmegen, The Netherlands. , (Netherlands)
Published Article
Journal of Neurology Neurosurgery & Psychiatry
Publication Date
Nov 01, 2017
DOI: 10.1136/jnnp-2016-314697
PMID: 28844070


Cerebral amyloid angiopathy (CAA) has never been more relevant. The last 5 years have seen a rapid increase in publications and research in the field, with the development of new biomarkers for the disease, thanks to advances in MRI, amyloid positron emission tomography and cerebrospinal fluid biomarker analysis. The inadvertent development of CAA-like pathology in patients treated with amyloid-beta immunotherapy for Alzheimer's disease has highlighted the importance of establishing how and why CAA develops; without this information, the use of these treatments may be unnecessarily restricted. Our understanding of the clinical and radiological spectrum of CAA has continued to evolve, and there are new insights into the independent impact that CAA has on cognition in the context of ageing and intracerebral haemorrhage, as well as in Alzheimer's and other dementias. While the association between CAA and lobar intracerebral haemorrhage (with its high recurrence risk) is now well recognised, a number of management dilemmas remain, particularly when considering the use of antithrombotics, anticoagulants and statins. The Boston criteria for CAA, in use in one form or another for the last 20 years, are now being reviewed to reflect these new wide-ranging clinical and radiological findings. This review aims to provide a 5-year update on these recent advances, as well as a look towards future directions for CAA research and clinical practice.

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