nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/20742711-2023-6-85-94nnp-2143Research ArticleCLINICAL OBSERVATIONSКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯComorbidity of cerebral amyloid angiopathy and Alzheimer's disease. Clinical case analysisКоморбидность церебральной амилоидной ангиопатии и болезни Альцгеймера. Анализ клинического случаяhttps://orcid.org/0000-0001-5801-1480ЕмелинА. Ю.EmelinA. Yu.

Андрей Юрьевич Емелин

194044, Санкт-Петербург, ул. Академика Лебедева, 6

6, Academician Lebedev St., St. Petersburg 194044

emelinand@rambler.ruhttps://orcid.org/0000-0003-3109-8795ЛобзинВ. Ю.LobzinV. Yu.

194044, Санкт-Петербург, ул. Академика Лебедева, 6; 191015, Санкт-Петербург, ул. Кирочная, 41

6, Academician Lebedev St., St. Petersburg 194044; 41, Kirochnaya St., St. Petersburg 191015

https://orcid.org/0000-0003-2249-1405ЕфимцевА. Ю.EfimtsevA. Yu.

197341, Санкт-Петербург, ул. Аккуратова, 2

2, Akkuratova St., St. Petersburg 197341

https://orcid.org/0000-0002-4830-907XВоробьевС. В.VorobyovS. V.

197341, Санкт-Петербург, ул. Аккуратова, 2; 194100, Санкт-Петербург, Литовская ул., 2

2, Akkuratova St., St. Petersburg 197341; 2, Litovskaya St., St. Petersburg 194100

ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны РоссииРоссияS.M. Kirov Military Medical Academy, Ministry of Defense of RussiaRussian FederationФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны России; ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава РоссииРоссияS.M. Kirov Military Medical Academy, Ministry of Defense of Russia; I.I. Mechnikov North-Western State Medical University, Ministry of Health of RussiaRussian FederationФГБУ «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава РоссииРоссияAlmazov National Medical Research Center, Ministry of Health of RussiaRussian FederationФГБУ «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава России; ФГБОУ ВО «Санкт-Петербургский государственный педиатрический медицинский университет» Минздрава России, Санкт-ПетербургРоссияAlmazov National Medical Research Center, Ministry of Health of Russia; Saint Petersburg State Pediatric Medical University, Ministry of Health of RussiaRussian Federation2023171220231568594Copyright © Emelin A.Y., Lobzin V.Y., Efimtsev A.Y., Vorobyov S.V., 20232023Емелин А.Ю., Лобзин В.Ю., Ефимцев А.Ю., Воробьев С.В.Emelin A.Y., Lobzin V.Y., Efimtsev A.Y., Vorobyov S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/2143

The development of cognitive impairment in old age is often caused by overlapping neurodegenerative and cerebrovascular changes which have a mutually aggravating clinical effect. In recent years, the problem of cerebral amyloid angiopathy (CAA), which is one of the variants of such an interaction, has gained importance. Despite the frequent occurrence of this pathology in the elderly, a unified approach to the treatment of these patients has not yet been developed, especially taking into account the frequent combination with other nosological forms. CAA is a disease associated with both Alzheimer's type neurodegeneration and cerebrovascular pathology. The article presents a clinical case illustrating this situation and discusses the diagnostic algorithm in detail. The characteristics of the pathogenesis and clinical manifestations of CAA and the link between neurodegenerative and cerebrovascular pathologies are discussed.

Развитие когнитивных нарушений в пожилом возрасте часто обусловлено перекрывающимися нейродегенеративными и цереброваскулярными изменениями, оказывающими взаимоотягощающий клинический эффект. В последние годы отмечается повышенный интерес к проблеме церебральной амилоидной ангиопатии (ЦАА), представляющей собой один из вариантов такого взаимодействия. Несмотря на частую встречаемость данной патологии у лиц пожилого возраста, не разработан единый подход к тактике ведения таких пациентов, особенно с учетом частого сочетания с другими нозологическими формами. ЦАА является состоянием, коморбидным как с нейродегенерацией альцгеймеровского типа, так и с цереброваскулярной патологией. В статье представлен клинический случай, иллюстрирующий данное положение, подробно разобран алгоритм диагностики. Обсуждаются особенности патогенеза и клинических проявлений ЦАА, связь нейродегенеративной и цереброваскулярной патологии.

болезнь Альцгеймерацеребральная амилоидная ангиопатияцереброваскулярная болезньспорадическая неамилоидная ангиопатияболезнь малых сосудовкогнитивные нарушениянейровизуализацияAlzheimer's diseasecerebral amyloid angiopathycerebrovascular diseasesporadic non-amyloid angiopathysmall vessel diseasecognitive impairmentneuroimagingИсследование не имело спонсорской поддержкиThe investigation has not been sponsoredReferencesCorriveau RA, Bosetti F, Emr M, et al. The Science of Vascular Contributions to Cognitive Impairment and Dementia (VCID): A Framework for Advancing Research Priorities in the Cerebrovascular Biology of Cognitive Decline. Cell Mol Neurobiol. 2016 Mar;36(2):281-8. doi: 10.1007/s10571-0160334-7. Epub 2016 Apr 19.Corriveau RA, Bosetti F, Emr M, et al. The Science of Vascular Contributions to Cognitive Impairment and Dementia (VCID): A Framework for Advancing Research Priorities in the Cerebrovascular Biology of Cognitive Decline. Cell Mol Neurobiol. 2016 Mar;36(2):281-8. doi: 10.1007/s10571-0160334-7. Epub 2016 Apr 19.Arvanitakis Z, Capuano AW, Leurgans SE, et al. Relation of cerebral vessel disease to Alzheimer's disease dementia and cognitive function in elderly people: a cross-sectional study. Lancet Neurol. 2016 Aug;15(9):934-43. doi: 10.1016/S1474-4422(16)30029-1. Epub 2016 Jun 14.Arvanitakis Z, Capuano AW, Leurgans SE, et al. Relation of cerebral vessel disease to Alzheimer's disease dementia and cognitive function in elderly people: a cross-sectional study. Lancet Neurol. 2016 Aug;15(9):934-43. doi: 10.1016/S1474-4422(16)30029-1. Epub 2016 Jun 14.Biessels GJ. Alzheimer's disease, cerebrovascular disease and dementia: lump, split or integrate? Brain. 2022 Aug 27;145(8):2632-4. doi: 10.1093/brain/awac228Biessels GJ. Alzheimer's disease, cerebrovascular disease and dementia: lump, split or integrate? Brain. 2022 Aug 27;145(8):2632-4. doi: 10.1093/brain/awac228Greenberg SM, Bacskai BJ, Hernandez-Guillamon M, et al. Cerebral amyloid angiopathy and Alzheimer disease – one peptide, two pathways. Nat Rev Neurol. 2020 Jan;16(1):30-42. doi: 10.1038/s41582-019-0281-2. Epub 2019 Dec 11.Greenberg SM, Bacskai BJ, Hernandez-Guillamon M, et al. Cerebral amyloid angiopathy and Alzheimer disease – one peptide, two pathways. Nat Rev Neurol. 2020 Jan;16(1):30-42. doi: 10.1038/s41582-019-0281-2. Epub 2019 Dec 11.Keage HA, Carare RO, Friedland RP, et al. Population studies of sporadic cerebral amyloid angiopathy and dementia: a systematic review. BMC Neurol. 2009 Jan 13;9:3. doi: 10.1186/1471-2377-9-3Keage HA, Carare RO, Friedland RP, et al. Population studies of sporadic cerebral amyloid angiopathy and dementia: a systematic review. BMC Neurol. 2009 Jan 13;9:3. doi: 10.1186/1471-2377-9-3Jellinger KA. Alzheimer disease and cerebrovascular pathology: an update. J Neural Transm (Vienna). 2002 May;109(56):813-36. doi: 10.1007/s007020200068Jellinger KA. Alzheimer disease and cerebrovascular pathology: an update. J Neural Transm (Vienna). 2002 May;109(56):813-36. doi: 10.1007/s007020200068Jäkel L, De Kort AM, Klijn CJM, et al. Prevalence of cerebral amyloid angiopathy: A systematic review and meta-analysis. Alzheimers Dement. 2022 Jan;18(1):10-28. doi: 10.1002/alz.12366. Epub 2021 May 31.Jäkel L, De Kort AM, Klijn CJM, et al. Prevalence of cerebral amyloid angiopathy: A systematic review and meta-analysis. Alzheimers Dement. 2022 Jan;18(1):10-28. doi: 10.1002/alz.12366. Epub 2021 May 31.Charidimou A, Boulouis G, Gurol ME, et al. Emerging concepts in sporadic cerebral amyloid angiopathy. Brain. 2017 Jul 1;140(7):1829-50. doi: 10.1093/brain/awx047Charidimou A, Boulouis G, Gurol ME, et al. Emerging concepts in sporadic cerebral amyloid angiopathy. Brain. 2017 Jul 1;140(7):1829-50. doi: 10.1093/brain/awx047Greenberg SM, Charidimou A. Diagnosis of Cerebral Amyloid Angiopathy: Evolution of the Boston Criteria. Stroke. 2018 Feb;49(2):491-7. doi: 10.1161/STROKEAHA.117.016990. Epub 2018 Jan 15.Greenberg SM, Charidimou A. Diagnosis of Cerebral Amyloid Angiopathy: Evolution of the Boston Criteria. Stroke. 2018 Feb;49(2):491-7. doi: 10.1161/STROKEAHA.117.016990. Epub 2018 Jan 15.Charidimou A, Boulouis G, Frosch MP, et al. The Boston criteria version 2.0 for cerebral amyloid angiopathy: a multicentre, retrospective, MRI-neuropathology diagnostic accuracy study. Lancet Neurol. 2022 Aug;21(8):71425. doi: 10.1016/S1474-4422(22)00208-3Charidimou A, Boulouis G, Frosch MP, et al. The Boston criteria version 2.0 for cerebral amyloid angiopathy: a multicentre, retrospective, MRI-neuropathology diagnostic accuracy study. Lancet Neurol. 2022 Aug;21(8):71425. doi: 10.1016/S1474-4422(22)00208-3Новосадова ОА, Кулеш АА, Григорьева ВН. Диагностика церебральной амилоидной ангиопатии: на пути к Бостонским критериям 2.0. Российский неврологический журнал. 2020;25(5):4-13. doi: 10.30629/2658-7947-2020-25-5-4-13Novosadova OA, Kulesh AA, Grigoryeva VN. Diagnostics of cerebral amyloid angiopathy: the way to Boston criteria 2.0. Rossiiskii nevrologicheskii zhurnal = Russian Neurological Journal. 2020;25(5):4-13. doi: 10.30629/26587947-2020-25-5-4-13 (In Russ.).Di Stefano F, Epelbaum S, Coley N, et al; GuidAge study group. Prediction of Alzheimer's Disease Dementia: Data from the GuidAge Prevention Trial. J Alzheimers Dis. 2015;48(3):793-804. doi: 10.3233/JAD-150013Di Stefano F, Epelbaum S, Coley N, et al; GuidAge study group. Prediction of Alzheimer's Disease Dementia: Data from the GuidAge Prevention Trial. J Alzheimers Dis. 2015;48(3):793-804. doi: 10.3233/JAD-150013Емелин АЮ, Одинак ММ, Труфанов ГЕ и др. Возможности позитронной эмиссионной компьютерной томографии в дифференциальной диагностике деменций. Вестник Российской Военно-медицинской академии. 2010;4(32):46-51.Emelin AYu, Odinak MM, Trufanov GE, et al. Possibilities of positron emission computed tomography in the differential diagnosis of dementia. Vestnik Rossiiskoi Voenno-meditsinskoi akademii. 2010;4(32):46-51 (In Russ.).Del Sole A, Malaspina S, Magenta Biasina A. Magnetic resonance imaging and positron emission tomography in the diagnosis of neurodegenerative dementias. Funct Neurol. 2016 Oct/Dec;31(4):205-15. doi: 10.11138/fneur/2016.31.4.205Del Sole A, Malaspina S, Magenta Biasina A. Magnetic resonance imaging and positron emission tomography in the diagnosis of neurodegenerative dementias. Funct Neurol. 2016 Oct/Dec;31(4):205-15. doi: 10.11138/fneur/2016.31.4.205Cordonnier C, Leys D, Dumont F, et al. What are the causes of pre-existing dementia in patients with intracerebral haemorrhages? Brain. 2010 Nov;133(11):3281-9. doi: 10.1093/brain/awq246. Epub 2010 Sep 17.Cordonnier C, Leys D, Dumont F, et al. What are the causes of pre-existing dementia in patients with intracerebral haemorrhages? Brain. 2010 Nov;133(11):3281-9. doi: 10.1093/brain/awq246. Epub 2010 Sep 17.Xiong L, Reijmer YD, Charidimou A, et al. Intracerebral hemorrhage and cognitive impairment. Biochim Biophys Acta. 2016 May;1862(5):939-44. doi: 10.1016/j.bbadis.2015.12.011. Epub 2015 Dec 12.Xiong L, Reijmer YD, Charidimou A, et al. Intracerebral hemorrhage and cognitive impairment. Biochim Biophys Acta. 2016 May;1862(5):939-44. doi: 10.1016/j.bbadis.2015.12.011. Epub 2015 Dec 12.Reijmer YD, Fotiadis P, Martinez-Ramirez S, et al. Structural network alterations and neurological dysfunction in cerebral amyloid angiopathy. Brain. 2015 Jan;138(Pt 1):179-88. doi: 10.1093/brain/awu316. Epub 2014 Nov 2.Reijmer YD, Fotiadis P, Martinez-Ramirez S, et al. Structural network alterations and neurological dysfunction in cerebral amyloid angiopathy. Brain. 2015 Jan;138(Pt 1):179-88. doi: 10.1093/brain/awu316. Epub 2014 Nov 2.Attems J, Jellinger K, Thal DR, Van Nostrand W. Review: sporadic cerebral amyloid angiopathy. Neuropathol Appl Neurobiol. 2011 Feb;37(1):75-93. doi: 10.1111/j.1365-2990.2010.01137.xAttems J, Jellinger K, Thal DR, Van Nostrand W. Review: sporadic cerebral amyloid angiopathy. Neuropathol Appl Neurobiol. 2011 Feb;37(1):75-93. doi: 10.1111/j.1365-2990.2010.01137.xHall CN, Reynell C, Gesslein B, et al. Capillary pericytes regulate cerebral blood flow in health and disease. Nature. 2014 Apr 3;508(7494):55-60. doi: 10.1038/nature13165. Epub 2014 Mar 26.Hall CN, Reynell C, Gesslein B, et al. Capillary pericytes regulate cerebral blood flow in health and disease. Nature. 2014 Apr 3;508(7494):55-60. doi: 10.1038/nature13165. Epub 2014 Mar 26.Love S, Chalmers K, Ince P, et al. Development, appraisal, validation and implementation of a consensus protocol for the assessment of cerebral amyloid angiopathy in post-mortem brain tissue. Am J Neurodegener Dis. 2014 Mar 28;3(1):19-32. Erratum in: Am J Neurodegener Dis. 2015;4(2):49.Love S, Chalmers K, Ince P, et al. Development, appraisal, validation and implementation of a consensus protocol for the assessment of cerebral amyloid angiopathy in post-mortem brain tissue. Am J Neurodegener Dis. 2014 Mar 28;3(1):19-32. Erratum in: Am J Neurodegener Dis. 2015;4(2):49.Кулеш АА, Дробаха ВЕ, Шестаков ВВ. Геморрагические проявления церебральной амилоидной ангиопатии – от патогенеза к клиническому значению. Неврология, нейропсихиатрия, психосоматика. 2018;10(3):4-11. doi: 10.14412/2074-2711-2018-3-4-11Kulesh AA, Drobakha VE, Shestakov VV. Hemorrhagic manifestations of cerebral amyloid angiopathy: from pathogenesis to clinical significance. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2018;10(3):4-11. doi: 10.14412/2074-2711-2018-3-4-11 (In Russ.).Араблинский АВ, Макотрова ТА, Левин ОС. Церебральные микрокровоизлияния при сосудистых и нейродегенеративных заболеваниях. Журнал неврологии и психиатрии им. С.С. Корсакова. Спецвыпуски. 2013;113(7-2):45-52.Arablinskii AV, Makotrova TA, Levin OS. Cerebral microbleeds in cerebrovascular and neurodegenerative diseases. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2013;113(7-2):45-52 (In Russ.).Лобзин ВЮ, Колмакова КА, Емелин АЮ, Лапина АВ. Глимфатическая система мозга и ее роль в патогенезе болезни Альцгеймера. Вестник Российской Военномедицинской академии. 2019;1(65):230-6.Lobzin VYu, Kolmakova KA, Emelin AYu, Lapina AV. The glymphatic system of the brain and its role in the pathogenesis of Alzheimer's disease. Vestnik Rossiyskoy Voyenno-meditsinskoy akademii. 2019;1(65):230-6 (In Russ.).Carare RO, Kalaria R. Cerebrovascular pathology: the dark side of neurodegeneration. Acta Neuropathol. 2016 May;131(5):641-3. doi: 10.1007/s00401-016-1573-xCarare RO, Kalaria R. Cerebrovascular pathology: the dark side of neurodegeneration. Acta Neuropathol. 2016 May;131(5):641-3. doi: 10.1007/s00401-016-1573-xKeable A, Fenna K, Yuen HM, et al. Deposition of amyloid β in the walls of human leptomeningeal arteries in relation to perivascular drainage pathways in cerebral amyloid angiopathy. Biochim Biophys Acta. 2016 May;1862(5):1037-46. doi: 10.1016/j.bbadis.2015.08.024. Epub 2015 Aug 29.Keable A, Fenna K, Yuen HM, et al. Deposition of amyloid β in the walls of human leptomeningeal arteries in relation to perivascular drainage pathways in cerebral amyloid angiopathy. Biochim Biophys Acta. 2016 May;1862(5):1037-46. doi: 10.1016/j.bbadis.2015.08.024. Epub 2015 Aug 29.Rabin JS, Nichols E, La Joie R, et al. Cerebral amyloid angiopathy interacts with neuritic amyloid plaques to promote tau and cognitive decline. Brain. 2022 Aug 27;145(8):2823-33. doi: 10.1093/brain/awac178Rabin JS, Nichols E, La Joie R, et al. Cerebral amyloid angiopathy interacts with neuritic amyloid plaques to promote tau and cognitive decline. Brain. 2022 Aug 27;145(8):2823-33. doi: 10.1093/brain/awac178Парфенов ВА, Коберская НН. Болезнь Альцгеймера. Москва: ИМА-ПРЕСС; 2022. 156 с.Parfenov VA, Koberskaya NN. Bolezn' Al'tsgeymera [Alzheimer's disease]. Moscow: IMA-PRESS; 2022. 156 p. (In Russ.).Dubois B, Villain N, Frisoni GB, et al. Clinical diagnosis of Alzheimer's disease: recommendations of the International Working Group. Lancet Neurol. 2021 Jun;20(6):484-96. doi: 10.1016/S1474-4422(21)00066-1. Epub 2021 Apr 29.Dubois B, Villain N, Frisoni GB, et al. Clinical diagnosis of Alzheimer's disease: recommendations of the International Working Group. Lancet Neurol. 2021 Jun;20(6):484-96. doi: 10.1016/S1474-4422(21)00066-1. Epub 2021 Apr 29.Емелин АЮ, Лобзин ВЮ, Воробьёв СВ. Когнитивные нарушения: руководство для врачей. Москва; 2019. 416 с.Emelin A Yu, Lobzin V Yu, Vorobyov SV. Kognitivnyye narusheniya: rukovodstvo dlya vrachey [Cognitive impairment: a guide for clinicians]. Moscow; 2019. 416 p. (In Russ.).Лобзин ВЮ. Комплексная ранняя диагностика нарушений когнитивных функций. Журнал неврологии и психиатрии им. С.С. Корсакова. 2015;115(11):72-9. doi: 10.17116/jnevro201511511172-79Lobzin VIu. Comprehensive early diagnosis of cognitive impairment. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2015;115(11):72-9. doi: 10.17116/jnevro201511511172-79 (In Russ.)].Blennow K, Zetterberg H. Biomarkers for Alzheimer's disease: current status and prospects for the future. J Intern Med. 2018 Dec;284(6):643-63. doi: 10.1111/joim.12816. Epub 2018 Aug 19.Blennow K, Zetterberg H. Biomarkers for Alzheimer's disease: current status and prospects for the future. J Intern Med. 2018 Dec;284(6):643-63. doi: 10.1111/joim.12816. Epub 2018 Aug 19.McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on AgingAlzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011 May;7(3):263-9. doi: 10.1016/j.jalz.2011.03.005. Epub 2011 Apr 21.McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on AgingAlzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011 May;7(3):263-9. doi: 10.1016/j.jalz.2011.03.005. Epub 2011 Apr 21.Jack CR Jr, Bennett DA, Blennow K, et al; Contributors. NIA-AA Research Framework: Toward a biological definition of Alzheimer's disease. Alzheimers Dement. 2018 Apr;14(4):535-62. doi: 10.1016/j.jalz.2018.02.018Jack CR Jr, Bennett DA, Blennow K, et al; Contributors. NIA-AA Research Framework: Toward a biological definition of Alzheimer's disease. Alzheimers Dement. 2018 Apr;14(4):535-62. doi: 10.1016/j.jalz.2018.02.018Theodorou A, Tsantzali I, Kapaki E, et al. Cerebrospinal fluid biomarkers and apolipoprotein E genotype in cerebral amyloid angiopathy. A narrative review. Cereb Circ Cogn Behav. 2021 Mar 21;2:100010. doi: 10.1016/j.cccb.2021.100010Theodorou A, Tsantzali I, Kapaki E, et al. Cerebrospinal fluid biomarkers and apolipoprotein E genotype in cerebral amyloid angiopathy. A narrative review. Cereb Circ Cogn Behav. 2021 Mar 21;2:100010. doi: 10.1016/j.cccb.2021.100010Charidimou A, Pantoni L, Love S. The concept of sporadic cerebral small vessel disease: A road map on key definitions and current concepts. Int J Stroke. 2016 Jan;11(1):6-18. doi: 10.1177/1747493015607485Charidimou A, Pantoni L, Love S. The concept of sporadic cerebral small vessel disease: A road map on key definitions and current concepts. Int J Stroke. 2016 Jan;11(1):6-18. doi: 10.1177/1747493015607485

The authors declare that there are no conflicts of interest present.