Cerebrovascular Pathology and Dementia in Autopsied Honolulu‐Asia Aging Study Participants

Abstract

Clinicopathologic data from 285 autopsies were analyzed. The decedents were long-standing participants in the Honolulu-Asia Aging Study, a prospective epidemiologic investigation of stroke, neurodegenerative diseases, and aging. We assessed the prevalence at death of four primary neuropathologic processes using specific microscopic lesions as indicators. An algorithm was developed to assign each decedent to one of six subsets, corresponding to pathologic dominance by microvascular lesions (14% of decedents), Alzheimer lesions (12%), hippocampal sclerosis (5%), cortical Lewy bodies (5%), codominance by two or more primary processes (9%), or without a dominant pathologic process recognized (55%). Definite or probable dementia had been identified in 118 of the decedents. The proportions of men in each subset identified as demented were (in the same order) 57%, 53%, 79%, 57%, 76%, and 25%. In this autopsied panel of older Japanese-American men, the importance of microvascular lesions as a likely explanation for dementia was nearly equal to that of Alzheimer lesions. The cerebrovascular lesion type most essentially and inclusively related to dementia was multiple microinfarction.

Microinfarcts in an older population‐representative brain donor cohort (MRC CFAS): Prevalence, relation to dementia and mobility, and implications for the evaluation of cerebral Small Vessel Disease

“…In view of the above considerations, we have examined our data to see if the assertion arising from the Honolulu Asian Ageing Study, that microinfarcts are of particular significance as predictors of clinically expressed SVD, is justified in this cohort 10. We show that the inclusion of microinfarcts does modestly increase the number of brains examined to which a diagnosis of SVD can be assigned using our criteria.…”

In Vivo Detection of Cerebral Cortical Microinfarcts with High-Resolution 7T MRI

“…2,7 In the neuropathologic literature, there is no consensus on the definition of the size of a CMI. Some studies report an upper limit for CMI size as 'microscopic' or 'not visible to the naked eye,' but several studies also classify lesions up to a few mm in size as CMIs.…”

Cerebral Microinfarcts: A Systematic Review of Neuropathological Studies

“…Two studies found microinfarcts only in the watershed areas (Suter et al, 2002;Strozyk et al, 2010), others only in the cortical gray matter (Olichney et al, 1997;Lee et al, 2000). White et al (2002) found cortical microinfarcts mostly located toward the base of the gray matter, while Okamoto et al (2009) described them mostly in the superficial layers of the cortex.…”

“…The most commonly used neuropathological criteria for AD were the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) (Mirra et al, 1991) and the Braak criteria (Braak and Braak, 1991). Fifteen studies (41%) primarily classified the patients on clinical criteria (Erkinjuntti et al, 1988;Vinters et al, 2000;Xuereb et al, 2000;White et al, 2002;Gold et al, 2007;Sonnen et al, 2007;Schneider et al, 2007a, b;Strozyk et al, 2010;Troncoso et al, 2008;White, 2009;Wang et al, 2009;Brayne et al, 2009;Ghebremedhin et al, 2010;Sinka et al, 2010;Arvanitakis et al, 2011). The Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) was used most frequently, followed by the Cognitive Assessment Screening Instrument (Teng et al, 1994).…”

“…Some studies used a semiquantitative scale, for example 0, 1 to 2, and > 2 microinfarcts (with corresponding prevalence that ranged from 6% with multiple microinfarcts in nondemented individuals to 31% in patients with dementia) (Sonnen et al, 2007); < 3; 3; Z4 in the basal ganglia and thalamus and < 3; 3 to 4; Z5 in the neocortex (81% of the patients had < 3 microinfarcts in both categories, 1% the highest category) (White et al, 2002); or 'multiple' (Vinters et al, 2000;Lee et al, 2000). The remaining studies mentioned the number of microinfarcts per patient more precisely: 0 to 4 in patients with different types of dementia (Erkinjuntti et al, 1988); a mean of six microinfarcts (range 1 to 37) in 14 patients with severe CAA and 3 (range 1 to 6) in 7 patients with mild CAA (Soontornniyomkij et al, 2010); 1 to 4 per watershed zone area (Suter et al, 2002).…”