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Peer-reviewedCC BY-NC-ND 4.0The Journal of Prevention of Alzheimer's Disease

Cerebral microhemorrhage and cognition in preclinical Alzheimer’s disease

  • Dobri Baldaranov1
  • Shunran Wang1
  • Rema Raman1
  • Karin Ernstrom1
  • Kejal Kantarci2
  • Clifford R. Jack2
  • Reisa A Sperling3
  • Paul S Aisen1
  • Michael S Rafii1
  1. 1Epstein Family Alzheimer’s Therapeutic Research Keck School of Medicine, University of Southern California, San Diego, CA, 90033, USA
  2. 2Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Departments of Neurology, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
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Abstract

Background: Clarifying whether incident cerebral microhemorrhages (CMHs) contribute to early cognitive or functional decline is increasingly important in the context of anti-amyloid therapies.

Objective: To determine whether incident CMHs are associated with longitudinal changes in cognition and function in cognitively unimpaired individuals with elevated cerebral amyloid.

Design, Setting, and Participants: Post hoc analysis of individuals enrolled in the A4 study. Participants underwent serial MRI and cognitive assessments. Natural cubic spline models adjusted for baseline amyloid PET burden, age, sex, education, and APOE ε4 status.

Measurements: Longitudinal change in the Preclinical Alzheimer Cognitive Composite (PACC), Clinical Dementia Rating–Sum of Boxes (CDR-SB), Cognitive Function Index (CFI), and Activities of Daily Living.

Results: Participants who developed ≥2 incident CMHs demonstrated greater longitudinal worsening in CDR-SB (estimate = 0.44; 95% CI, 0.09–0.80; P = .009) and CFI (estimate = 1.37; 95% CI, 0.11–2.60; P = .03), but not in PACC or ADCS ADL.

Conclusions: Incident CMH accumulation was associated with greater longitudinal worsening in global clinical status and participant-reported functional change, but not objective cognitive performance, among cognitively unimpaired individuals with elevated cerebral amyloid.

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Cite

BibTeXRIS
BibTeX
@article{baldaranov2026cerebral,
  title = {{Cerebral microhemorrhage and cognition in preclinical Alzheimer’s disease}},
  author = {Dobri Baldaranov and Shunran Wang and Rema Raman and Karin Ernstrom and Kejal Kantarci and Clifford R. Jack and Reisa A Sperling and Paul S Aisen and Michael S Rafii},
  journal = {The Journal of Prevention of Alzheimer's Disease},
  year = {2026},
  month = oct,
  doi = {10.1016/j.tjpad.2026.100681},
  url = {https://doi.org/10.1016/j.tjpad.2026.100681},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Cerebral microhemorrhage and cognition in preclinical Alzheimer’s disease
AU  - Dobri Baldaranov
AU  - Shunran Wang
AU  - Rema Raman
AU  - Karin Ernstrom
AU  - Kejal Kantarci
AU  - Clifford R. Jack
AU  - Reisa A Sperling
AU  - Paul S Aisen
AU  - Michael S Rafii
PY  - 2026
DA  - 2026/10/19
JO  - The Journal of Prevention of Alzheimer's Disease
DO  - 10.1016/j.tjpad.2026.100681
UR  - https://doi.org/10.1016/j.tjpad.2026.100681
AB  - Background: Clarifying whether incident cerebral microhemorrhages (CMHs) contribute to early cognitive or functional decline is increasingly important in the context of anti-amyloid therapies.  Objective: To determine whether incident CMHs are associated with longitudinal changes in cognition and function in cognitively unimpaired individuals with elevated cerebral amyloid.  Design, Setting, and Participants: Post hoc analysis of individuals enrolled in the A4 study. Participants underwent serial MRI and cognitive assessments. Natural cubic spline models adjusted for baseline amyloid PET burden, age, sex, education, and APOE ε4 status.  Measurements: Longitudinal change in the Preclinical Alzheimer Cognitive Composite (PACC), Clinical Dementia Rating–Sum of Boxes (CDR-SB), Cognitive Function Index (CFI), and Activities of Daily Living.  Results: Participants who developed ≥2 incident CMHs demonstrated greater longitudinal worsening in CDR-SB (estimate = 0.44; 95% CI, 0.09–0.80; P = .009) and CFI (estimate = 1.37; 95% CI, 0.11–2.60; P = .03), but not in PACC or ADCS ADL.  Conclusions: Incident CMH accumulation was associated with greater longitudinal worsening in global clinical status and participant-reported functional change, but not objective cognitive performance, among cognitively unimpaired individuals with elevated cerebral amyloid.
SN  - 2274-5807
SN  - 2426-0266
ER  -