J Stroke.  2024 May;26(2):179-189. 10.5853/jos.2023.04287.

Prevalence of Cerebral Amyloid Angiopathy Pathology and Strictly Lobar Microbleeds in East-Asian Versus Western Populations: A Systematic Review and Meta-Analysis

• Kort AMD
• Verbeek MM
• Schreuder FH
• Klijn CJ
• Jäkel L

• KMID: 2556040
• DOI: http://doi.org/10.5853/jos.2023.04287

Abstract

Background and Purpose
Possible differences in the prevalence of cerebral amyloid angiopathy (CAA) in East-Asian compared to Western populations have received little attention, and results so far have been ambiguous. Our aim is to compare the prevalence of CAA neuropathology and magnetic resonance imaging markers of CAA in East-Asian and Western cohorts reflecting the general population, cognitively normal elderly, patients with Alzheimer’s disease (AD), and patients with (lobar) intracerebral hemorrhage (ICH).
Methods
We performed a systematic literature search in PubMed and Embase for original research papers on the prevalence of CAA and imaging markers of CAA published up until February 17th 2022. Records were screened by two independent reviewers. Pooled estimates were determined using random-effects models. We compared studies from Japan, China, Taiwan, South Korea (East-Asian cohorts) to studies from Europe or North America (Western cohorts) by meta-regression models.
Results
We identified 12,257 unique records, and we included 143 studies on Western study populations and 53 studies on East-Asian study populations. Prevalence of CAA neuropathology did not differ between East-Asian and Western cohorts in any of the investigated patient domains. The prevalence of strictly lobar microbleeds was lower in East-Asian cohorts of population-based individuals (5.6% vs. 11.4%, P=0.020), cognitively normal elderly (2.6% vs. 11.4%, P=0.001), and patients with ICH (10.2% vs. 24.6%, P<0.0001). However, age was in general lower in the East-Asian cohorts.
Conclusion
The prevalence of CAA neuropathology in the general population, cognitively normal elderly, patients with AD, and patients with (lobar) ICH is similar in East-Asian and Western countries. In East-Asian cohorts reflecting the general population, cognitively normal elderly, and patients with ICH, strictly lobar microbleeds were less prevalent, likely due to their younger age. Consideration of potential presence of CAA is warranted in decisions regarding antithrombotic treatment and potential new anti-amyloid-β immunotherapy as treatment for AD in East-Asian and Western countries alike.

Keyword

Cerebral amyloid angiopathy; Prevalence; Epidemiology; Asia; Europe; Microbleeds

Figure

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  Figure 1. Flow diagram depicting the identification of records during three searches of PubMed and Embase as well the inclusion and exclusion of records during different screening stages. CAA, cerebral amyloid angiopathy.

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  Figure 2. Of 196 included studies, 76 reported on European populations (one study pooled participants from Belgium and UK), 68 on North American study populations (one study pooled participants from The Netherlands and USA), and 53 reported on East-Asian study populations (in yellow). Included Western countries are indicated in red. In addition, 10 studies were conducted in other countries (of which in one study, the country was unclear).

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