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Significant CNS involvement has been noted, emphasizing the necessity for advanced neuroimaging tools for early detection of CNS damage in ATTRv.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Comprehensive clinical assessments and multimodal MRI techniques, including FreeSurfer, TBSS and microbleed analysis, were utilized. The cohorts comprised 30 symptomatic patients (ATTRv\u2010PN), 19 presymptomatic patients (pre\u2010ATTRv\u2010PN), classified based on neuropathic signs, and 44 age\u2010 and sex\u2010matched controls. For cognitive assessment, we utilized the Addenbrooke's Cognitive Examination\u2010Revised.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The ATTRv\u2010PN group had an average age of 51\u2009years, while the pre\u2010ATTRv\u2010PN group averaged 41\u2009years, with a sex ratio of 35% men to 65% women. Symptomatic patients experienced an average disease duration of 5\u2009years, predominantly featuring the p.Val50Met genotype (73%). Brain imaging showed diffuse subcortical white matter alterations in ATTRv\u2010PN, while cortical thinning and microbleeds were infrequent. Cognitive assessments revealed significant differences, with symptomatic scoring lower in memory and verbal fluency than presymptomatic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ATTRv\u2010PN involves cerebral white matter microstructural damage from early stages. Multimodal MRI serves as an accurate, non\u2010invasive tool for detecting CNS damage, improving our understanding of the disease spectrum.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ene.70427","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T09:43:50Z","timestamp":1767865430000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Early Detection of Central Nervous System Involvement in\n                    <scp>ATTRv<\/scp>\n                    Using Multimodal\n                    <scp>MRI<\/scp>\n                    and Cognitive Assessments"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6560-0061","authenticated-orcid":false,"given":"Renan Fl\u00e1vio","family":"de Fran\u00e7a Nunes","sequence":"first","affiliation":[{"name":"Department of Neurology, School of Medical Sciences University of Campinas (UNICAMP)  Campinas 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