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Staging and natural history of cerebrovascular pathology in dementia

V Deramecourt1, J Y Slade, A E Oakley

  • 1Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.

Neurology
|March 2, 2012
PubMed

Insights

Vascular changes are common in dementia patients. A new rating scheme helps quantify cerebrovascular pathology, aiding understanding of dementia and cognitive decline.

Area of Science:

  • Neuropathology
  • Vascular Dementia Research
  • Neurodegenerative Diseases

Background:

  • Elderly individuals frequently exhibit vascular changes, often co-occurring with neurodegenerative conditions like Alzheimer disease (AD) or dementia with Lewy bodies (DLB).
  • The cumulative impact of cerebrovascular lesions is linked to cognitive decline (vascular cognitive impairment), but quantifying this pathology remains challenging, creating uncertainty in its relationship with cognitive decline.
  • Existing methods lack consensus for quantifying cerebrovascular pathology, hindering a clear understanding of its role in dementia.

Purpose of the Study:

  • To develop a standardized rating scheme for cerebrovascular lesions in postmortem brains of dementia patients.
  • To establish a method for neuropathologic quantification of cerebrovascular burden in dementia.

Main Methods:

  • Investigated 135 postmortem brains with diagnoses including vascular dementia (VaD), AD, DLB, and combinations.
  • Rated cerebrovascular lesions on large tissue sections from key brain regions: hippocampus, temporal lobe, frontal lobe, and basal ganglia.

Main Results:

  • Arteriolosclerosis and amyloid angiopathy were the most frequent and earliest observed vessel wall modifications in dementia patients.
  • Alterations in perivascular spaces and myelin loss were also commonly noted.
  • Lacunar or regional infarcts were identified as potential consequences of independent processes or late-stage small vessel diseases.

Conclusions:

  • A proposed staging system, based on a conceptual model of cerebrovascular pathology, can facilitate neuropathologic quantification of cerebrovascular burden in dementia.
  • Further research is required to validate this system for large-scale studies and to elucidate clinical-cerebrovascular pathologic correlations.
Abstract

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