Diagnostic criteria for cerebral amyloid angiopathy
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The Boston criteria version 2.0[1] is a set of guidelines designed to diagnose cerebral amyloid angiopathy (CAA), a disease that affects small blood vessels in the brain, particularly those in the cortex and leptomeninges. Although the gold standard for diagnosis is histopathological examination, the Boston criteria provide clinicians with a probabilistic approach for diagnosis largely based on imaging characteristics.[2]
CAA is characterized by the progressive accumulation of a protein called amyloid β in the walls of these blood vessels. CAA is a major cause of lobar intracerebral haemorrhage, which is bleeding in the brain that occurs in the lobes of the brain. CAA is also a contributing factor to age-related cognitive impairment, which is a decline in cognitive function that occurs with aging.
It is important to accurately diagnose CAA during a patient's lifetime because it can affect clinical care and research participation.
Accurate diagnosis can also help researchers enroll appropriate participants in studies aimed at understanding the disease and developing new treatments.
The Boston criteria are intended to provide high diagnostic accuracy with reasonable simplicity, making them useful for both clinical practice and research. The criteria are designed to be applicable across the clinical spectrum of CAA-related presentations, meaning they can be used to diagnose the disease in patients with a variety of symptoms and conditions. The criteria are also intended to be used across clinical settings, meaning they can be applied in different healthcare environments and by different healthcare professionals.
In a study published in 2023, the authors found that the Boston criteria v2.0 substantially increases the proportion of patients with lobar ICH classified as probable CAA in comparison to the Boston criteria v1.5.[3]
^Charidimou, Andreas; Boulouis, Gregoire; Frosch, Matthew P; Baron, Jean-Claude; Pasi, Marco; Albucher, Jean Francois; Banerjee, Gargi; Barbato, Carmen; Bonneville, Fabrice; Brandner, Sebastian; Calviere, Lionel; Caparros, François; Casolla, Barbara; Cordonnier, Charlotte; Delisle, Marie-Bernadette (August 2022). "The Boston criteria version 2.0 for cerebral amyloid angiopathy: a multicentre, retrospective, MRI–neuropathology diagnostic accuracy study". The Lancet Neurology. 21 (8): 714–725. doi:10.1016/S1474-4422(22)00208-3. PMC 9389452. PMID 35841910.
^Schroeder, B. E.; Robertson, N. P.; Hughes, T. A. T. (2023-03-24). "Cerebral amyloid angiopathy: an update". Journal of Neurology. 270 (5): 2809–2811. doi:10.1007/s00415-023-11631-3. ISSN 0340-5354. PMC 10130108. PMID 36961527.
^Du, Yang; Zhang, Wenpeng; Locatelli, Martina; Simister, Robert J.; Jäger, H. Rolf; Werring, David J. (June 2023). "The Boston criteria version 2.0 increase the proportion of lobar intracerebral haemorrhage classified as probable cerebral amyloid angiopathy". Journal of Neurology. 270 (6): 3243–3245. doi:10.1007/s00415-023-11565-w. ISSN 1432-1459. PMID 36656357. S2CID 255973102.
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