Boston criteria for cerebral amyloid angiopathy

The Boston criteria were first proposed in 1995 in order to standardise the diagnosis of cerebral amyloid angiopathy (CAA) 1. They comprise of combined clinical, imaging and pathological parameters. 

The criteria are divided into four tiers and are as 3-4:

  • definite CAA
    • full post-mortem examination reveals lobar, cortical, or cortical/subcortical haemorrhage and pathological evidence of severe cerebral amyloid angiopathy
  • probable CAA with supporting pathological evidence
    • clinical data and pathological tissue (evacuated haematoma or cortical biopsy specimen) demonstrate a haemorrhage as mentioned above and some degree of vascular amyloid deposition
    • doesn't have to be post-mortem
  • probable CAA
    • pathological confirmation not required
    • patient older than 55 years
    • appropriate clinical history 
    • MRI findings demonstrate multiple haemorrhages of varying sizes/ages with no other explanation 
  • possible CAA
    • patient older than 55 years
    • appropriate clinical history 
    • MRI findings reveal a single lobar, cortical, or cortical/subcortical haemorrhage without another cause, multiple haemorrhages with a possible but not a definite cause, or some haemorrhage in an atypical location

The Boston criteria for diagnosis of 'probable CAA' was pathologically validated in 2009 and was found to be highly specific (100%, 95% confidence interval (CI) 77% to 100%), but only had a sensitivity of 44% (95% CI 28% to 62%) 2. Hence, while the patients who meet the Boston Criteria for probable CAA are likely to have underlying CAA, over half the patients with CAA are also missed and not picked up by these criteria. Since then, another criteria, the Modified Boston criteria, has been proposed.


Neurodegenerative diseases

Neurodegenerative diseases are legion and their classification just as protean. A useful approach is to divide them according to underlying pathological process, although even using this schema, there is much overlap and thus resulting confusion.

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rID: 12492
Synonyms or Alternate Spellings:
  • Boston criteria

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