Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Artif Intell Med Imaging. Jun 28, 2020; 1(1): 65-69
Published online Jun 28, 2020. doi: 10.35711/aimi.v1.i1.65
Cerebral amyloid angiopathy vs Alzheimer’s dementia: Diagnostic conundrum
Jamie Arberry, Sarneet Singh, Ruth Akiyo Mizoguchi
Jamie Arberry, Sarneet Singh, Ruth Akiyo Mizoguchi, Chelsea and Westminster Hospital, London SW10 9NH, United Kingdom
Author contributions: Arberry J and Mizoguchi RA were the patient’s physicians, Arberry J and Singh S reviewed the literature and drafted the manuscript; all authors were responsible for the revision of the manuscript and issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient.
Conflict-of-interest statement: No conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Jamie Arberry, BM BCh, Doctor, Chelsea and Westminster Hospital, 369 Fulham Palace Road, London SW10 9NH, United Kingdom.
Received: March 17, 2020
Peer-review started: March 17, 2020
First decision: June 5, 2020
Revised: June 15, 2020
Accepted: June 18, 2020
Article in press: June 18, 2020
Published online: June 28, 2020

Diagnosis of a dementia subtype can be complex and often requires comprehensive cognitive assessment and dedicated neuroimaging. Clinicians are prone to cognitive biases when reviewing such images. We present a case of cognitive impairment and demonstrate that initial imaging may have resulted in misleading the diagnosis due to such cognitive biases.


A 76-year-old man with no cognitive impairment presented with acute onset word finding difficulty with unremarkable blood tests and neurological examination. Magnetic resonance imaging (MRI) demonstrated multiple foci of periventricular and subcortical microhaemorrhage, consistent with cerebral amyloid angiopathy (CAA). Cognitive assessment of this patient demonstrated marked impairment mainly in verbal fluency and memory. However, processing speed and executive function are most affected in CAA, whereas episodic memory is relatively preserved, unlike in other causes of cognitive impairment, such as Alzheimer’s dementia (AD). This raised the question of an underlying diagnosis of dementia. Repeat MRI with dedicated coronal views demonstrated mesial temporal lobe atrophy which is consistent with AD.


MRI brain can occasionally result in diagnostic overshadowing, and the application of artificial intelligence to medical imaging may overcome such cognitive biases.

Keywords: Alzheimer’s dementia, Cerebral amyloid angiopathy, Cognitive impairment, Microhaemorrhages, Artificial intelligence, Case report

Core tip: This case represents the complexities of diagnosing dementia subtypes with an unusual presentation for what is likely Alzheimer’s dementia, rather than cerebral amyloid angiopathy as per initial magnetic resonance imaging brain. In such cases, imaging can potentially influence the diagnostic accuracy, which might ultimately result in misdiagnosis and hence alter the management plan. We argue that artificial intelligence and image automation could avoid such diagnostic oversights.