Coupling between low-frequency hemodynamic oscillations and cerebrospinal fluid flow is altered in patients with cerebral amyloid angiopathy

Cerebral amyloid angiopathy (CAA) is characterized by the accumulation of amyloid-β in the vessel walls. Prominent manifestations of CAA include enlarged perivascular spaces (ePVS) and lower amyloid-β concentrations in CSF, which may be the result of impaired brain clearance. CAA patients also demonstrate impaired evoked vascular reactivity. Whether vascular dysfunction is associated with impaired fluid movement in the human brain remains unclear. Here we show that BOLD-CSF coupling is reduced in CAA patients compared to elderly controls, which is a first demonstration of a cerebral small vessel disease affecting CSF motion.