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Lobar Microbleeds in the Posterior Cortical Atrophy Syndrome: A Comparison to Typical Alzheimer’s Disease

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Abstract

Purpose of the study

Posterior cortical atrophy is a clinico-radiographical syndrome that presents with higher-order visual dysfunction and is most commonly due to Alzheimer’s disease. Understanding factors associated with atypical presentations of Alzheimer’s disease, such as posterior cortical atrophy (PCA), holds promise to shape our understanding of AD pathophysiology. Thus, we aimed to compare MRI evidence of lobar microbleeds (LMBs) in posterior cortical atrophy (PCA) syndrome to typical AD (tAD) and to assess and compare MRI evidence of cerebral amyloid angiopathy (CAA) in each group.

Findings

We retrospectively collected clinical and MRI data from participants with PCA (n = 26), identified from an institutional PCA registry, and participants with tAD (n = 46) identified from electronic health records from a single institution. LMBs were identified on susceptibility-weighted imaging (SWI); the Fazekas grade of white matter disease was assessed using FLAIR images, and Boston criteria version 2.0 for cerebral amyloid angiopathy were applied to all data. The proportion of participants with PCA and LMB (7.7%) was lower than for tAD (47.8%) (p = 0.005). The frequency of “probable” CAA was similar in both groups, while “possible” CAA was more frequent in tAD (30.4%) than PCA (0%) (p = 0.001). The Fazekas grades were not different between groups.

Summary

Lobar microbleeds on SWI were not more common in PCA than in typical AD. Clinicopathological investigations are necessary to confirm these findings. The factors that contribute to the posterior cortical atrophy phenotype are unknown.

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Data Availability

Data available upon reasonable request.

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Acknowledgements

The editors would like to thank Dr. John Brust for taking the time to review this manuscript. We thank Jerri Lusk, Program Assistant I at the University of Colorado, for help with manuscript preparation and administrative support, and Jody Tanabe, MD, Professor of Radiology and Chief of Neuroradiology at the University of Colorado, for access to the typical AD cohort. We are indebted to our patients and their families and care partners.

Funding

Partial financial support for VSP was received from the University of Colorado School of Medicine (UCSOM) John and Joanne Hare Posterior Cortical Atrophy Research Fund and the UCSOM Brain and Vision Fund. BMB receives research support from NIH (NIA: R01 AG058772; R21AG072153) and the Department of Defense (W81XWH-19–1-0520). PP receives research funding from NIA R61 AG074859-01, NIA R01 AG071151-01, and NIA K23 AG063900-01A1.

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Authors and Affiliations

  1. Department of Neurology, University of Colorado School of Medicine, 12631 East 17 Avenue, Mail Stop B185, Aurora, CO, 80045, USA

    Victoria S. Pelak, Vishal Krishnan, Stephanie Serva, Peter Pressman, Asher Mahmood, Lily Noteboom, Brianne M. Bettcher & Stefan H. Sillau

  2. Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA

    Andrew L. Callen & Ashesh A. Thaker

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  1. Victoria S. Pelak
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Correspondence to Victoria S. Pelak.

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Conflict of Interest

The following authors have no relevant financial or non-financial interests to disclose: LN, AM, SS, VK, AC, AT. VSP is a member of the editorial board of Current Neurology and Neurosciences Report. All other authors report no competing interests. Financial interests: VSP has received research support from NIH, the John and Joanne Hare Fund for Accelerating PCA Research, University of Colorado Alzheimer’s and Cognition Center, the North American Neuro-ophthalmology Society and institutional support from the Lewy Body Dementia Association as the PI for the LBDA Research Center of Excellence; VSP has also received support from the American Academy of Neurology for editorial work, royalties from Up-to-Date, Inc., as a member of the Alzheimer’s Association for the LEADS Patient Advocacy Committee, as a member of the Medical Advisory Board for Esai, and as a PI for clinical trials affiliated with Biogen and Eisai. PP has received research support from NIH, the Doris Duke Fund to Retain Clinical Scientists, and the Mary Massack Brinker Memorial Dementia Research Fund. BMB has received research support from NIH, the Department of Defense, and the University of Colorado School of Medicine. SHS has received research support from the NIH and the Alzheimer’s Association. ALC is a consultant for Eli Lilly. Non-financial interests: VSP is a member of the following boards and receives no compensation as a member: Board of Directors of the North American Neuro-ophthalmology Society and the Medical Advisory Board of the Benign Essential Blepharospasm Research Foundation. ALC is a Medical Advisory Board Member of the Spinal CSF Leak Foundation and Member for the North American Neuro-ophthalmology Society Illustrated Curriculum, Brain & Life Magazine, StatPearls Behavioral Neurology and Neuropsychiatry Section, Neurology Clinical Practice, and the Journal of Neuro-ophthalmology.

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Pelak, V.S., Krishnan, V., Serva, S. et al. Lobar Microbleeds in the Posterior Cortical Atrophy Syndrome: A Comparison to Typical Alzheimer’s Disease. Curr Neurol Neurosci Rep 24, 27–33 (2024). https://doi.org/10.1007/s11910-024-01330-5

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