Population studies of sporadic cerebral amyloid angiopathy and dementia: a systematic review

Keage, Hannah A.D., Carare, Roxanna O., Friedland, Robert P., Ince, Paul G., Love, Seth, Nicoll, James A., Wharton, Stephen B., Weller, Roy O. and Brayne, Carol (2009) Population studies of sporadic cerebral amyloid angiopathy and dementia: a systematic review. BMC Neurology, 9 (3). (doi:10.1186/1471-2377-9-3).

Abstract

Background

Deposition of amyloid-? (A?) in vessel walls of the brain as cerebral amyloid angiopathy (CAA) could be a major factor in the pathogenesis of dementia. Here we investigate the relationship between dementia and the prevalence of CAA in older populations. We searched the literature for prospective population-based epidemiological clinicopathological studies, free of the biases of other sampling techniques, which were used as a comparison.

Methods

To identify population-based studies assessing CAA and dementia, a previous systematic review of population-based clinicopathological studies of ageing and dementia was employed. To identify selected-sample studies, PsychInfo (1806–April Week 3 2008), OVID MEDLINE (1950–April Week 2 2008) and Pubmed (searched 21 April 2008) databases were searched using the term "amyloid angiopathy". These databases were also employed to search for any population-based studies not included in the previous systematic review. Studies were included if they reported the prevalence of CAA relative to a dementia classification (clinical or neuropathological).

Results

Four population-based studies were identified. They showed that on average 55–59% of those with dementia displayed CAA (of any severity) compared to 28–38% of the non-demented. 37–43% of the demented displayed severe CAA in contrast to 7–24% of the non-demented. There was no overlap in the range of these averages and they were less variable and lower than those reported in 38 selected sample studies (demented v non-demented: 32–100 v 0–77% regardless of severity; 0–50 v 0–11% for severe only).

Conclusion

CAA prevalence in populations is consistently higher in the demented as compared to the non-demented. This supports a significant role for CAA in the pathogenesis of dementia.

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Contributors

Author: Roxanna O. Carare

Author: James A. Nicoll

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