Cerebral amyloid angiopathy (CAA) is characterized by the pathologic deposition of
amyloid-beta within cortical and leptomeningeal arteries, arterioles, capillaries and, in rare cases, the venules of the brain. It is often associated with the development of lobar
intracerebral hemorrhages (ICHs) but may cause other
neurologic symptoms or be asymptomatic. Magnetic resonance imaging characteristics, such as lobar microbleeds, support a diagnosis of CAA and assist with
hemorrhage risk assessments.
Immunosuppressants are used to treat rarer inflammatory forms of CAA. For the more common forms of CAA, the use of
antihypertensive medications can prevent ICH recurrence while the use of antithrombotics may increase
hemorrhage risk. Anti-
amyloid approaches to treatment have not yet been investigated in phase 3 trials. Areas covered: A literature search was conducted using MEDLINE on the topics of imaging,
biomarkers, ICH prevention and treatment trials in CAA, focusing on its current diagnosis and management and opportunities for future therapeutic approaches. Expert commentary: There is likely a significant unrecognized burden of CAA in the elderly population. Continued research efforts to discover
biomarkers that allow the early diagnosis of CAA will enhance the opportunity to develop treatment interventions.