Neuropathological assessment of the lesions of significance in vascular dementia

Abstract

Objectives-To better define the neuropathology of vascular dementia. Methods-The neuropathological findings in 18 elderly, undemented subjects free of cerebrovascular disease were compared with 19 elderly undemented subjects who had cerebrovascular disease (many of whom had had a "stroke") and 24 elderly demented subjects who had cerebrovascular disease, but no other pathology to account for dementia. Cases in all groups were selected for absence or no more than very mild Alzheimer type pathology. Results-Microvascular brain damage in the form of severe cribriform change and associated subcortical white matter damage and microinfarction were correlated with a history of dementia. Severe cribriform change was much more common and microinfarction somewhat more common in the demented group with vascular disease than the undemented group with vascular disease (P=0.0006 and P=0.031 respectively). Other findings of note were that congophilic angiopathy had a greater prevalence in the vascular dementia group than the control group, single cerebral infarcts were more common in the group who were undemented with vascular disease than in the group with dementia and vascular disease (P=0.0028), and the last group lacked evidence of macroscopic infarction more often than the first (P=0.034). There was a non-significant trend for the ratio of infarcted:uninfarcted tissue in one cerebral hemisphere to be higher in the group with dementia and vascular disease than in the group with vascular disease but no dementia. Conclusions-Microvascular disease, not macroscopic infarction, was the chief substrate of vascular dementia in this series of cases.

Voxel-based morphometry demonstrates reduced grey matter density on brain MRI in patients with diabetic retinopathy

“…Although some studies point to a possible causal relationship with dementia [30][31][32][33], others challenge this point of view [34]. Shrinkage and atrophy of the brain are generally considered to be a risk factor for cognitive decline [35][36][37][38][39].…”

Cerebral Microinfarcts: A Systematic Review of Neuropathological Studies

“…Six studies reported on a combination of people with and without dementia described as a single group. Two studies assessed patients with stroke (Esiri et al, 1997;Santos et al, 2009), one study elderly without describing their cognitive status (Longstreth et al, 2009). Three papers concerned patients with cerebral amyloid angiopathy (CAA) (Olichney et al, 1997;Soontornniyomkij et al, 2010;De Reuck et al, 2011a).…”

“…Thirteen studies (41%) diagnosed the patients primarily on neuropathological criteria (Esiri et al, 1997;Olichney et al, 1997;Suter et al, 2002;Rossi et al, 2004;Del Ser et al, 2005;Yip et al, 2005;Haglund et al, 2006;Isojima et al, 2006;Kö vari et al, 2007;Longstreth et al, 2009;Okamoto et al, 2009;De Reuck et al, 2011a, b). 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).…”

“…In five studies on VaD, with a total sample size of 87 (range 4 to 27), the frequency of microinfarcts ranged from 16.7% to 100%, with a weighted average of 62% (Erkinjuntti et al, 1988;Esiri et al, 1997;Haglund et al, 2006;Brayne et al, 2009;Okamoto et al, 2009).…”

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

“…Such lesions are a common finding at autopsy in older individuals 2. They are typically considered to measure less than 1 mm in maximum diameter, although no consensus definition exists, and are frequently much smaller.…”