The role of biopsies and autopsies in the diagnosis of cognitive impairment, with emphasis on small vessel diseases: A critical appraisal enriched by personal experience

Abstract

ABSTRACT.Acquired and hereditary microangiopathies cause cerebral small vessel diseases (CSVD) that impair cognition. The most frequent is primary angiitis of the CNS (PACNS), whose diagnosis remains challenging, requiring a multidisciplinary approach. Secondary vasculitis, CADASIL, miscellaneous microangiopathies and lymphomas, also cause cognitive impairment. Despite the fact that the need for biopsy has decreased in the era of new neuroimaging methods, biopsies that include small leptomeningeal and parenchymal arterial vessels still remain the gold standard to diagnose PACNS and other CSVD, and to exclude mimics such as infections and malignancies. New approaches for pathological consequences relevant to vascular cognitive impairment such as silent brain lesions, microinfarcts, microbleeds and subtle loss of microstructural integrity, may be detected in autopsies. This article addresses the role of biopsies and autopsies for the diagnosis of cognitive impairment related to small vessel diseases or other inflammatory/ischemic processes, and presents a critical appraisal based on personal experience.

Neuropathological Lesions and Cognitive Abilities in Black and White Older Adults in Brazil

“…Although siderocalcinosis has been related to cognitive impairment in our previous studies, siderocalcinosis was not reported by other studies, which makes impossible the comparison of our finding of siderocalcinosis being more frequent in Black participants. Siderocalcinosis is a vascular mineralization with an encrustation of calcium and iron in the elastic fibers of the media layer of the cerebral arteries, which is often regarded as a normal aspect of aging . Further studies on the racial differences of siderocalcinosis are needed.…”

Поражение Центральной Нервной Системы При Васкулитах

“…Гистологическое исследование имеет важное значение для проведения дифференциальной диагностики (в том числе с вторичными васкулитами ЦНС при инфекционных поражениях сосудов или злокачественных заболеваниях), и ее отрицательный результат может привести к альтернативному диагнозу. Выявленные при биопсии характерные для васкулита изменения являются основным критерием перевода диагноза из категории вероятного в категорию определенного [21]. Обычно биопсия проводится в правой (недоминантной) лобной доле с захватом лептоменингеальной ткани.…”