Based on the differences in the distribution of affected vessels between cerebral amyloid angiopathy (CAA) and hypertensive cerebral small vessel disease (HTN-CSVD), it is hypothesized that there is a spatial distribution difference in cerebral atrophy. This study aims to determine the clinical features of CAA brain atrophy.

CAA is an age-related cerebral small vessel disease that can lead to poor outcomes due to cerebral hemorrhage. The same applies to HTN-CSVD. Cerebral atrophy is a common imaging manifestation of CSVD, but its imaging patterns in both CAA and HTN-CSVD and clinical relevance have not been fully elucidated.

This is a retrospective study. Statistical Parametric Mapping 12 was used to obtain voxel-based morphology of cerebral atrophy shown on 5.0T MRI, including total intracranial volume, gray matter volume, white matter volume and cerebrospinal fluid volume. A voxel-wise multiple regression analysis clarifies the correlation between cerebral atrophy and cognitive decline in CAA.

After adjusting for age, gender, and total intracranial volume, cerebral atrophy differences between CAA and HTN-CSVD were mainly observed in the cortex of bilateral cerebellum (p < 0.05 FWE). The percentage of cerebellar cortex volume in total intracranial volume was related to gait speed and stride length, after adjusting for age, sex, height, and weight. Regional brain volume in the left medial temporal lobe, insula, parietal lobe, and thalamus was associated with mini-mental state examination scores (p < 0.05 FDR), and cerebral atrophy in the left lateral temporal lobe and right cerebellar hemisphere was associated with Montreal Cognitive Assessment scores (p < 0.05 FDR).

Cerebral atrophy in CAA is predominantly in the cerebellum. Cerebellar cortex volume correlates with gait. Cerebral atrophy is independently associated with overall cognitive levels prominantly in left temporal lobe.