Ischemic stroke is the only neurological manifestation included in APS diagnostic criteria, but many other neurological manifestations occur, including cognitive dysfunction and dementia. Generalized cerebral atrophy is reported in APS, but no specific regions of atrophy. 

To assess global and individual atrophy of cortical lobes in Antiphospholipid Syndrome (APS) patients.

Seventy-eight subjects (30 APS, 30 age-matched normal controls, 18 Alzheimer (AD) controls) were identified through neurology and rheumatology clinics. Three blinded neuroradiologists evaluated axial FLAIR images for all subjects, subjectively scoring the atrophy of each of eight cortical lobes using an ordinal atrophy scale of 0 – 3 (0-none, 1-mild, 2-moderate, 3-severe). Lobes with pre-existing stroke were excluded from analysis (19 of 976 lobes analyzed). Maximal lobe atrophy was used per patient and the 3 readers’ scores were averaged. Interrater agreement was moderate (kappa from 0.4-0.6). 

Demographics were: APS patients 80% female, mean age 49; normal controls 60% female, mean age 48; AD controls 61% female, mean age 60. In APS subjects, the mean +/- SD atrophy scores were: temporal 0.7±0.6, frontal 0.8±0.7, occipital 0.5±0.7, parietal 1.3±0.9. The mean difference in atrophy scores between APS patients and normal controls (APS-controls) were:0.41 temporal, 0.49 frontal, 0.38 occipital, 0.78parietal (twice the atrophy), p<0.002 for all comparisons. Comparing APS and AD, the mean difference in atrophy scores (APS-AD) were: temporal -0.57, frontal -0.22, occipital -0.02, and parietal 0.13 (all non-significant except temporal with p=0.03, with AD having more temporal atrophy). 

APS patients, in addition to global atrophy, have focal parietal lobe atrophy compared to normal controls. An atrophy pattern that is specific to the parietal lobes without commensurate temporal lobe atrophy should make one consider APS. Future studies will use quantitative atrophy analysis.