Cortical superficial siderosis in the general population: The Framingham Heart and Rotterdam studies

Ashkan Shoamanesh*, Saloua Akoudad, Jayandra J. Himali, Alexa S. Beiser, Charles DeCarli, Sudha Seshadri, M. Arfan Ikram, Jose R. Romero, Meike W. Vernooij

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)

Abstract

Objective: We aimed to characterize cortical superficial siderosis, its determinants and sequel, in community-dwelling older adults. Methods: The sample consisted of Framingham (n = 1724; 2000–2009) and Rotterdam (n = 4325; 2005–2013) study participants who underwent brain MRI. In pooled individual-level analysis, we compared baseline characteristics in patients with cortical superficial siderosis to two reference groups: (i) persons without hemorrhagic MRI markers of cerebral amyloid angiopathy (no cortical superficial siderosis and no microbleeds) and (ii) those with presumed cerebral amyloid angiopathy based on the presence of strictly lobar microbleeds but without cortical superficial siderosis. Results: Among a total of 6049 participants, 4846 did not have any microbleeds or cortical superficial siderosis (80%), 401 had deep/mixed microbleeds (6.6%), 776 had strictly lobar microbleeds without cortical superficial siderosis (12.8%) and 26 had cortical superficial siderosis with/without microbleeds (0.43%). In comparison to participants without microbleeds or cortical superficial siderosis and to those with strictly lobar microbleeds but without cortical superficial siderosis, participants with cortical superficial siderosis were older (OR 1.09 per year, 95% CI 1.05, 1.14; p < 0.001 and 1.04, 95% CI 1.00, 1.09; p = 0.058, respectively), had overrepresentation of the APOE ɛ4 allele (5.19, 2.04, 13.25; p = 0.001 and 3.47, 1.35, 8.92; p = 0.01), and greater prevalence of intracerebral hemorrhage (72.57, 9.12, 577.49; p < 0.001 and 81.49, 3.40, >999.99; p = 0.006). During a mean follow-up of 5.6 years, 42.4% participants with cortical superficial siderosis had a stroke (five intracerebral hemorrhage, two ischemic strokes and four undetermined strokes), 19.2% had transient neurological deficits and 3.8% developed incident dementia. Conclusion: Our study adds supporting evidence to the association between cortical superficial siderosis and cerebral amyloid angiopathy within the general population. Community-dwelling persons with cortical superficial siderosis may be at high risk for intracerebral hemorrhage and future neurological events.

Original languageEnglish
Pages (from-to)798-808
Number of pages11
JournalInternational Journal of Stroke
Volume16
Issue number7
Early online date21 Jan 2021
DOIs
Publication statusPublished - Oct 2021

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Framingham Heart Study’s National Heart, Lung, and Blood Institute contract (N01-HC-25195; HHSN268201500001I) and by grants from the National Institute of Neurological Disorders and Stroke (R01 NS17950), the National Institute on Aging (R01 AG008122; R01 AG16495; K23AG038444; R03 AG048180-01A1; AG033193), NIH grants (1RO1 HL64753; R01 HL076784; 1 R01 AG028321, P30 AG010129, NS017950), and NHLBI grants (HL67288 and 2K24HL04334). The Rotterdam Study is supported by Erasmus Medical Center and Erasmus University Rotterdam; the Netherlands Organisation for Scientific Research (NWO); the Netherlands Organisation for Health Research and Development (ZonMW); the Research Institute for Diseases in the Elderly (RIDE); the Netherlands Genomics Initiative (NGI); the Ministry of Education, Culture and Science; the Ministry of Health, Welfare and Sports; the European Commission (DG XII); and the Municipality of Rotterdam.

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Framingham Heart Study?s National Heart, Lung, and Blood Institute contract (N01-HC-25195; HHSN268201500001I) and by grants from the National Institute of Neurological Disorders and Stroke (R01 NS17950), the National Institute on Aging (R01 AG008122; R01 AG16495; K23AG038444; R03 AG048180-01A1; AG033193), NIH grants (1RO1 HL64753; R01 HL076784; 1 R01 AG028321, P30 AG010129, NS017950), and NHLBI grants (HL67288 and 2K24HL04334). The Rotterdam Study is supported by Erasmus Medical Center and Erasmus University Rotterdam; the Netherlands Organisation for Scientific Research (NWO); the Netherlands Organisation for Health Research and Development (ZonMW); the Research Institute for Diseases in the Elderly (RIDE); the Netherlands Genomics Initiative (NGI); the Ministry of Education, Culture and Science; the Ministry of Health, Welfare and Sports; the European Commission (DG XII); and the Municipality of Rotterdam.

Publisher Copyright:
© 2021 World Stroke Organization.

Fingerprint

Dive into the research topics of 'Cortical superficial siderosis in the general population: The Framingham Heart and Rotterdam studies'. Together they form a unique fingerprint.

Cite this