Spontaneous amyloid-related imaging abnormalities in a cognitively normal adult

An 81-year-old cognitively normal man ( APOE ε3/ε3) without risk factors had amyloid-related imaging abnormalities with sulcal effusions and edema (ARIA-E), siderosis, and microhemorrhages (ARIA-H) on MRI (figure 1).1 He was identified from 1,006 participants followed with 3,385 MRIs in 2010–2013 in Alzheimer's Disease Neuroimaging Initiative (ADNI) 2/ADNI Grand Opportunities. Amyloid standard uptake value ratio on PET was 1.85 (positive) (figure 2). ARIA-E and associated ARIA-H can be observed in cognitively normal elderly without the APOE ε4 risk allele, who have no prior microhemorrhages, and who are not receiving amyloid-modifying treatments. Focal amyloid deposits around the region of ARIA-H suggest that cerebral amyloid angiopathy may be responsible for the occurrence of ARIA in this case.2