Brain atrophy is associated with antiphospholipid antibody syndrome with and without vascular pathology

Introduction: Antiphospholipid syndrome (APS) is an acquired autoimmune disorder that predisposes to thrombosis events. Patients with APS have elevated risk for cognitive impairment, mostly linked to ischemic vascular events. This study aims to investigate the prevalence and distribution of brain atrophy in patients with APS, with and without vascular pathology. Methods: This retrospective cohort study analyzed data from the Clalit Health Services database. We included patients aged 18 and older who were diagnosed with APS, confirmed by two separate positive laboratory results, and underwent brain MRI between January-2014 and April-2020. Patients were compared to an age-matched control group with negative APS laboratory results. MRI were visually rated for atrophy in specific brain regions using established scales as well as for ischemic lesions. Further analysis was conducted to compare APS patients with and without vascular pathology on imaging. Results: We included 269 patients, of which 200 with APS. Patients with APS showed higher rate of atrophy in the anterior temporal (p < 0.01), medial temporal (p = 0.045), and fronto-insula regions (p < 0.01) compared to controls. Among APS patients, those with vascular pathology exhibited more widespread atrophy than those without, however patients with APS and no vascular pathology still exhibited significant atrophy in the anterior temporal (p < 0.01) and fronto-insula(p < 0.01) regions compared to controls. Conclusion: Brain atrophy may be more common among patients with APS, particularly in the anterior temporal and fronto-insula regions, even in the absence of visible vascular pathology. These findings may suggest that brain atrophy in APS may not be solely attributed to ischemic events.