Cerebral blood flow decline in adults with sickle cell anemia: what does it mean and is treatment required?

Kirkham, Fenella J. and Dlamini, Nomazulu (2025) Cerebral blood flow decline in adults with sickle cell anemia: what does it mean and is treatment required? Neurology, 105 (9), [e214331]. (doi:10.1212/WNL.0000000000214331).

Abstract

Cerebral blood flow (CBF) is an indicator of brain health and a critical determinant of neuronal function, metabolism, and resilience to injury. Age-related trajectories of CBF have been reported in nonanemic healthy people, but not in people with sickle cell anemia (SCA). In this issue of Neurology®, Jordan et al. ¹ report a study in which they performed brain MRI and arterial spin labeling to assess gray matter CBF (GM-CBF) across a wide age range (6–45 years) in a large race-matched cross-sectional cohort of participants with hemoglobin AA (HbAA) or HbSS (homozygous SCA). In their study, CBF increased in participants with SCA by 5.03 mL/100 g/min per decade (95% CI 1.70–8.37) over the first 3 decades. By contrast, in line with previous data, CBF decreased by −5.20 mL/100 g/min per decade (95% CI −8.96 to 1.94) over 4 decades in controls. There are methodological differences in quantification of CBF measured using MRI, particularly regarding the postlabeling delay, making it difficult to compare this study with the previous literature, ^{2, 3} even in comparing the magnitude of the percentage difference between adults and children with HbAA and HbSS because the control data are reported for the whole population. ¹ However, this study adds to our current understanding of age-related CBF trajectories in SCA.

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Contributors

Author: Fenella J. Kirkham

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