DOI: 10.1002/alz.080629 ISSN: 1552-5260

Cerebral microhemorrhage associations in UK immigrants from the Middle East and North Africa (MENA)

Elizabeth Haddad, Nasim Sheikh‐Bahaei, Shayan Javid, Neda Jahanshad
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Geriatrics and Gerontology
  • Neurology (clinical)
  • Developmental Neuroscience
  • Health Policy
  • Epidemiology



People from the Middle East and North Africa (MENA) are highly underrepresented in health studies, yet, they are forecasted to contribute the most to increasing projections of dementia over the next 30 years (Nichols, 2022). Cerebral microhemorrhages, or microbleeds (CMBs) in the aging brain have been linked to small vessel disease and neurodegeneration and may provide a proxy for intervention studies to identify those at higher risk for ADRD (Charidimou, 2011). CMBs are related to hemorrhagic amyloid‐related imaging abnormalities (ARIA‐H) reported as adverse events in recent Alzheimer’s clinical trials of amyloid clearing medications (Sperling, 2011). Identifying those at elevated risk for ARIA‐H can help refine inclusion criteria for clinical trials and mitigate risk of complications from these medications. CMBs may be detected by MRI derived susceptibility weighted images (SWI) (Haacke, 2004). We’ve previously reported higher prevalences of metabolic and cardiovascular disorders in MENA compared to other immigrant populations in the UK (Jahanshad, 2022). Using a subset of these individuals with SWI (Miller, 2016), we investigated the effect of these diseases and lifestyle on the presence of CMBs detected on SWI.


185 MENA participants with SWI were included. We used MARS criteria (Gregoire, 2009) to identify CMBs on SWI and validated our findings using other sequences to exclude CMB ‘mimics’ (Figure 1). The number and position of CMBs were reported as well as their classification including ‘definite’, ‘possible’ and ‘total’. The effects of disease and lifestyle were investigated using association rule learning, and Chi‐squared/Fisher’s exact tests were used on the most prominent associations.


10 subjects had at least one definite CMB and 10 more had at least one possible CMB (Table 1). Combinations of male sex, diabetes, obesity, and high waist‐to‐hip ratio were found to have 100% likelihood for having a CMB. The presence of definite CMBs was associated with diabetes (p = 0.017) and overweight BMI (p = 0.017) (Figure 2).


CMBs were associated with male sex, diabetes, and abnormally high anthropometric measures in MENA populations. Future work will test a larger sample and continue to tease apart CMB associations with health markers in those from MENA countries.

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