Silent brain damage in iTTP tied to age, diabetes, and heart disease: Study
Such damage may increase patients' risk of future stroke, cognitive decline
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More than half of individuals who recover from an acute episode of immune-mediated thrombotic thrombocytopenic purpura (iTTP) may have silent brain damage — where evidence is seen on imaging scans despite patients not having specific symptoms — that can increase the risk of cognitive decline and future stroke, a new study found.
Older age was linked to a higher risk of this type of brain damage, which is known as silent cerebral infarction, or SCI. Importantly, the researchers additionally found that potentially modifiable conditions such as diabetes and heart and blood vessel disease were also tied to a greater future risk for patients.
According to the researchers, these findings suggest that “targeting modifiable risk factors in clinical remission is an important opportunity to improve outcomes including stroke and cognitive decline.” The team labeled these other coexisting conditions “significant independent predictors of SCI in patients with iTTP.”
Still, the scientists noted that “future research is needed to confirm our findings in larger cohorts and to explore interventions targeting these risk factors.”
The study, “Risk factors for silent cerebral infarction in immune-mediated thrombotic thrombocytopenic survivors,” was published in the British Journal of Haematology by a team of researchers in the U.S.
iTTP, also known as acquired TTP, occurs when the immune system mistakenly attacks an enzyme that helps control blood clotting. As a result, blood clots can form in small vessels when they shouldn’t, restricting blood flow and damaging organs, including the brain.
Higher risk of long-term health issues after acute iTTP episodes
Although advances in TTP treatment have greatly reduced the risk of death due to acute iTTP episodes — periods when symptoms suddenly appear — research shows that people who recover remain at increased risk of long-term health issues. Among potential future problems are high blood pressure, cardiovascular conditions such as stroke, depression, and cognitive impairment.
According to the team, one possible cause of cognitive impairment is silent cerebral infarction, known for short as SCIs. These are small areas of brain damage caused by reduced blood flow that can be seen on brain scans but do not cause obvious neurological symptoms.
“In the general population as well as in iTTP, SCI are associated with cognitive decline and the risk of future overt stroke,” the researchers wrote.
The team noted that these so-called silent brain injuries “are common among iTTP survivors” — even among those without a clinical history of stroke.
“However, patient-specific and acute-iTTP episode-related factors contributing to SCI risk remain underexplored,” the scientists wrote.
To examine these risk factors, the team analyzed data from 39 adults with iTTP who were enrolled between September 2020 and December 2024 in the ongoing neurological sequelae of TTP (NeST) study. All participants had undergone at least one brain scan while in clinical remission, meaning their disease was under control at the time of imaging.
Most participants (74.4%) were women, and the median age of the patients was 47.4 years. Brain scans were performed a median of 5.2 years after an iTTP diagnosis, with timing ranging from as early as two months to 20 years later. Participants had experienced a median of two acute iTTP episodes.
Modifiable factors shown to add to risk of silent brain damage
Overall, 20 participants (51.28%) showed evidence of SCI. The severity of these brain lesions varied, with some patients showing only mild changes and others having a higher burden of brain damage.
Analysis showed that older age at the time of the brain scan and higher peak levels of lactate dehydrogenase (LDH) — a marker of tissue damage — during an acute iTTP episode, were linked to more severe brain injury.
[These findings] underscore the critical need for regular screening and aggressive management of cardiovascular risk factors in patients recovering from iTTP to minimize long-term neurological damage.
When the investigators also accounted for other health conditions, age at the time of the brain scan, diabetes, and a prior history of cardiovascular disease — including stroke and coronary artery disease — were associated with a greater SCI burden.
“These results highlight that both modifiable (treatable comorbidities [or coexisting diseases]) and nonmodifiable factors contribute to the occurrence and severity of SCI in iTTP survivors,” the scientists wrote. They added that the findings back their belief that silent brain damage “is multifactorial in nature.”
According to the researchers, these findings “underscore the critical need for regular screening and aggressive management of cardiovascular risk factors in patients recovering from iTTP to minimize long-term neurological damage.”
