Cerebral amyloid angiopathy (CAA) is something many people have never heard of. Yet the condition—which causes proteins to build up in the brain’s blood vessels—is increasingly recognized as an important contributor to cognitive decline in older adults.
“This condition has always existed, but nowadays we have advanced MRI techniques that allow us to identify it at early stages and to discover more about it,” says Angelos Katramados, M.D., a neurologist at Henry Ford Health.
Dr. Katramados explains what causes CAA and what you can do to protect your brain health.
What Is CAA?
CAA develops from misfolded proteins called amyloid. Amyloid might sound familiar—it’s the same protein that clumps up into plaques in the brain in people with Alzheimer’s disease.
In Alzheimer’s disease, amyloid proteins build up between nerve cells in the brain. In CAA, the amyloid proteins build up inside blood vessels in the brain. Over time, the vessel walls weaken, making the brain vulnerable to bleeding, strokes and cognitive problems such as memory loss.
“CAA is primarily a disease of aging and is increasingly recognized as one of the major contributors to cognitive decline in later life,” Dr. Katramados says. Some degree of CAA is common in older adults, he adds. But only a portion of them will develop CAA that’s significant enough to cause complications.
Cognitive Health Services At Henry Ford
CAA Symptoms and Complications
CAA can affect people in various ways. It can cause bleeding in the brain—ranging from small “microbleeds” that don’t cause symptoms to larger hemorrhages that may cause symptoms such as:
- Balance problems
- Headache
- Language problems
- Seizures
- Vision changes
People with CAA can also experience episodes called “amyloid spells.” Those spells can look like seizures or small temporary strokes called transient ischemic attacks (TIAs). CAA can also lead to cognitive decline, causing problems with planning, judgment and memory.
But in the early stages of CAA, people often experience no symptoms at all. “Many patients accumulate ‘silent’ microbleeds over years before obvious symptoms emerge,” Dr. Katramados says.
The Link Between CAA and Dementia
There are multiple ways that CAA contributes to cognitive changes in older adults. Repeated microbleeds can damage the brain over time. But even without those bleeding episodes, the condition can affect the health of blood vessels in the brain, Dr. Katramados says. That can injure brain tissue over time and contribute to cognitive decline and dementia.
Because CAA and Alzheimer’s disease both involve the buildup of amyloid protein, they often go hand in hand. CAA can also contribute to vascular dementia, changes in thinking skills that can occur as a result of reduced blood flow to the brain.
“CAA and Alzheimer’s disease frequently coexist and can also overlap with vascular dementia,” Dr. Katramados says. “In reality, many older adults have a kind of “mixed dementia” in which these different conditions interact.”
CAA Treatment
In the past, doctors had no way of diagnosing CAA until after a person died and their brain could be examined. Today, advances in MRI imaging allow doctors to identify and diagnose the condition, Dr. Katramados says.
Unfortunately, there is not yet a treatment for CAA. However, patients with the condition can reduce their risk of brain bleeds and other complications by managing high blood pressure, Dr. Katramados says. “Strict blood pressure control is one of the most important things we can do,” he says. “And because of the risk of bleeding in the brain, doctors should carefully weigh the risks and benefits of blood-thinning medications for some patients.”
Other medications, including anti-seizure medicines and steroids to reduce inflammation, can also be helpful for CAA, depending on a patient’s symptoms.
How to Reduce Risk and Slow CAA
Lifestyle changes can slow the progression of CAA—and also help prevent people from developing the condition in the first place. Dr. Katramados recommends the eight lifestyle habits recommended by the American Heart Association for lifelong health:
- Eat well: Choose a heart-smart diet rich in whole foods, including lots of fruits, vegetables and lean protein.
- Be active: Aim for 2½ hours of moderate physical activity each week.
- Quit smoking: Avoid inhaled nicotine and marijuana products, Dr. Katramados says.
- Get plenty of sleep: Most adults should get 7 to 9 hours a night.
- Manage obesity: Try to reach and maintain a healthy weight.
- Control cholesterol: Treat high cholesterol with diet, exercise and/or medication.
- Manage blood sugar: Screen for and treat prediabetes and diabetes.
- Control blood pressure: High blood pressure is a significant cause of CAA complications. If yours is high, talk to your doctor about how to keep it in a healthy range.
These activities can go a long way toward preventing CAA and supporting the overall health of your whole body, Dr. Katramados says. “A healthy body is a healthy mind,” he says.
Reviewed by Angelos Katramados, M.D., a neurologist who sees patients at Henry Ford Hospital in Detroit.
