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Published on: April 23, 2021
Prevalence of small cerebral bleeds in patients with a neurodegenerative dementia: a neuropathological study
Jacques De Reuck1, Vincent Deramecourt, Charlotte Cordonnier
1Université Lille Nord de France, UDSL, F-59000 Lille, France. dereuck.j@gmail.com
Background:
Small cerebral bleeds are frequently observed on magnetic resonance imaging in patients with Alzheimer dementia (AD). Histological confirmations in post-mortem brains are scarce. This study describes the prevalence of cerebrovascular lesions and the quantification of the "bleeding load" in post-mortem brains of patients with neurodegenerative dementias.
Patients And Methods:
Forty-five brains of AD patients, 8 of dementia with Lewy bodies (DLB) and 12 of fronto-temporal dementia (FTD) were compared to 10 controls. Histological examination was performed for the evaluation of cerebral amyloid angiopathy (CAA), white matter changes (WMCs), micro-infarcts, and cerebral micro- and mini-bleeds (MnBs). The latter were evaluated semi-quantitatively on a coronal section of a whole cerebral hemisphere and on a horizontal section through the pons and cerebellum.
Results:
Arterial hypertension (AH) was the main vascular risk factor in the patients with AD and DLB (P<0.05). MnBs, consisting of small perivascular bleeds, were significantly more frequent (P<0.001) in AD brains. They were mainly and equally present in the cerebral cortex of AD and DLB brains (P=0.04). Combined AD and DLB pathologies were present in 15%. CAA and WMCs occurred more frequently in AD brains (P<0.001). Occasional MnBs were observed in 60% of the controls.
Conclusions:
This neuropathological study confirms the frequent presence of MnBs and WMCs in AD brains. The relative high incidence of cortical MnBs in DLB brains is probably due to the high incidence of AH and the frequent association with AD and CAA.
Insights
Post-mortem analysis reveals micro- and mini-bleeds (MnBs) are common in Alzheimer dementia (AD) brains, especially in the cortex. Dementia with Lewy bodies (DLB) also shows frequent MnBs, often linked to hypertension and AD pathology.
Area of Science:
- Neuropathology
- Neurodegenerative Diseases
- Cerebrovascular Health
Background:
- Small cerebral bleeds are common in Alzheimer dementia (AD) patients, but post-mortem histological data is limited.
- This study investigates cerebrovascular lesions and "bleeding load" in neurodegenerative dementia post-mortem brains.
Purpose of the Study:
- To determine the prevalence of cerebrovascular lesions, including micro- and mini-bleeds (MnBs), in post-mortem brains of patients with AD, dementia with Lewy bodies (DLB), and fronto-temporal dementia (FTD).
- To quantify the "bleeding load" and compare lesion frequency across different dementia types and controls.
Main Methods:
- Histological examination of 45 AD, 8 DLB, 12 FTD, and 10 control brains.
- Evaluation of cerebral amyloid angiopathy (CAA), white matter changes (WMCs), micro-infarcts, and MnBs.
- Semi-quantitative assessment of MnBs on coronal and horizontal brain sections.
Main Results:
- Arterial hypertension was a key risk factor in AD and DLB patients.
- Micro- and mini-bleeds (MnBs) were significantly more frequent in AD brains (P<0.001) and common in the cerebral cortex of both AD and DLB brains.
- Cerebral amyloid angiopathy (CAA) and white matter changes (WMCs) were more prevalent in AD brains.
Conclusions:
- This neuropathological study confirms frequent MnBs and WMCs in AD brains.
- The high incidence of cortical MnBs in DLB brains is likely due to arterial hypertension and co-existing AD and CAA pathologies.
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