White matter changes in old age dementia

This is the clinico-morphological study of 70 patients above age 60 with the clinical diagnosis of dementia made on clinico-psychometric criteria for the assessment of the deterioration-dementia state, and in some cases, using the Hachinski scale. For morphological macro- and microscopic examinations of the brain, the classic neuropathologic techniques were used. Although no case selection was carried out, the number of cases was uniformly distributed between the ages of 60-74 years. The sample was also relatively uniform with regard to the patients' sex. Morphologically, our patient group included cases with vascular dementia (VD-33%), mixed dementia (MD-14.3%), Alzheimer-type dementia (ATD-20%), isolated SAE (17%), other cases (15.7%). Myelinic pallors and rarefactions were present in 41.4% of all cases of which: as a single lesion in 41.4%, associated with VD in 34.5%, with MD in 17.2% and with ATD in 6.9%. Microscopic background of myelinic changes was represented by acute (perivascular and pericellular edema) and chronic (myelinic destruction, gliosis, perivascular hematic pigment) edematous lesions. In 10.3% of cases with myelinic changes, marked dilation and blood stasis in large periventricular and/or subcortical vessels with subsequent cerebral edema, generally overlapping critical zones of venous circulation could be observed. The size and severity of the myelinic lesions were not clearly correlated to the intra- and extraparenchymatous vascular changes. However, the myelinic involvement was more in cases with lesions, mainly atherosclerotic, of the vessel walls. The possible intervention of the venous factor in the development of subcortical arteriosclerotic encephalopathy (SAE) is discussed among other etiopathogenic factors.