Zerebrale Amyloidangiopathie

Die zerebrale Amyloidangiopathie (CAA) ist eine Erkrankung, bei der sich beta-Amyloid in den Gefäßwänden des Gehirns ablagert. Sie ist eine bedeutende Ursache für lobäre Hirnblutungen und Demenz. Der Beitrag beleuchtet die Epidemiologie, Pathophysiologie und klinischen Erscheinungsbilder der CAA, einschließlich ihrer inflammatorischen Variante. Zudem werden neueste Erkenntnisse zur iatrogenen CAA und zu Amyloid-assoziierten Bildgebungsabnormalitäten (ARIA) im Zusammenhang mit neuen Alzheimer-Therapien vorgestellt.

Kernaussagen

• Die CAA ist durch Ablagerungen von beta-Amyloid in Gefäßwänden des Gehirns gekennzeichnet und eine Hauptursache für lobäre intrazerebrale Blutungen.

• Die Prävalenz einer moderaten CAA bei 84-Jährigen wird auf etwa 23% geschätzt, bei Alzheimer-Patienten liegt sie bei 50–80%.

• Die Pathophysiologie der CAA verläuft in 4 Stadien, von ersten Ablagerungen bis hin zu klinisch symptomatischen Hirnblutungen.

• Mikroblutungen und kortikale superfiziale Siderose sind charakteristische MRT-Merkmale der CAA.

• Es gibt zunehmende Evidenz für ein „prionenähnliches Verhalten“ von beta-Amyloid, was zu iatrogener CAA führen kann.

• ARIA treten bei 40% der Patienten unter Anti-Amyloid-Immuntherapien wie Aducanumab auf und erfordern spezielle Behandlungsstrategien.

• Die CAA-ri zeigt ähnliche Risikofaktoren wie ARIA, unterscheidet sich aber in Häufigkeit und Schwere der Symptome.

Publication History

Article published online:
09 September 2024

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