Cerebral microbleeds and CSF Alzheimer biomarkers in primary progressive aphasias

Aline Mendes 1 Anne Bertrand 2 Foudil Lamari 3 Olivier Colliot 4 Alexandre Routier 5 Olivier Godefroy 6 Frédérique Etcharry-Bouyx 7 Olivier Moreaud 8, 9 Florence Pasquier 10 Philippe Couratier 11, 12 Karim Bennys 13 Martine Vercelletto 14 Olivier Martinaud 15 Bernard Laurent Jérémie Pariente 16 Michèle Puel 17 Stéphane Epelbaum 18 Serge Belliard 19 Takoua Kaaouana 18 Ludovic Fillon 20 Marie Chupin 4 Bruno Dubois 5 Marc Teichmann 21
Abstract : Objective : To reveal the prevalence and localization of cerebral microbleeds (CMBs) in the 3 main variants of primary progressive aphasia (PPA) (logopenic, semantic, and nonfluent/agrammatic), to identify the relationship with underlying Alzheimer pathology, and to explore whether CMBs contribute to language breakdown. Methods : We used a cross-sectional design in a multicenter cohort of 82 patients with PPA and 19 similarly aged healthy controls. MRI allowed for rating CMBs (2-dimensional gradient recalled echo T2*, susceptibility weighted imaging sequences) and white matter hyperintensities. CSF Alzheimer disease biomarker analyses available in 63 of the 82 patients provided the stratification of PPA into subgroups with patients who had or did not have probable underlying Alzheimer pathology. Results : The prevalence of CMBs was higher in patients with PPA (28%) than in controls (16%). They were more prevalent in logopenic PPA (50%) than in semantic PPA (18%) and nonfluent/agrammatic PPA (17%). The localization of CMBs was mainly lobar (81%) with no difference between the PPA variants. CMBs were more frequent in PPA patients with positive than with negative CSF Alzheimer disease biomarkers (67% vs 20%). Patients with and without lobar CMBs had similar volumes of white matter hyperintensities. Language and general cognitive impairment in PPA was unrelated to CMB rates. Conclusions: CMB prevalence in PPA is higher than in healthy controls. CMBs were most prevalent in the logopenic variant, were related to underlying Alzheimer pathology, and did not affect the language/cognitive impairment. Our findings also suggest that CMB detection with MRI contributes to PPA variant diagnosis, especially of logopenic PPA, and provides an estimator of the underlying neuropathology.
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Submitted on : Thursday, June 21, 2018 - 3:55:05 PM
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Aline Mendes, Anne Bertrand, Foudil Lamari, Olivier Colliot, Alexandre Routier, et al.. Cerebral microbleeds and CSF Alzheimer biomarkers in primary progressive aphasias. Neurology, American Academy of Neurology, 2018, 90 (12), pp.e1057 - e1065. ⟨10.1212/WNL.0000000000005165⟩. ⟨hal-01820415⟩

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