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Microvascular burden and Alzheimer-type lesions across the age spectrum

Alessandra Costanza1, Aikaterini Xekardaki, Enikö Kövari

  • 1Department of Psychiatry, University Hospitals and Faculty of Medicine of Geneva, Belle-Idée, Geneva, Switzerland.

Journal of Alzheimer'S Disease : JAD
|July 31, 2012
PubMed

Insights

Cortical microinfarcts are the primary driver of cognitive decline in aging brains, even with Alzheimer's disease pathology. These small brain lesions significantly impact cognition across various age groups.

Area of Science:

  • Neurology
  • Neuroscience
  • Pathology

Background:

  • Vascular lesions and Alzheimer's disease (AD) pathology are common in aging brains.
  • The link between macroscopic vascular lesions and dementia is established, but the cognitive impact of small vascular lesions remains debated.
  • Small vessel ischemic brain injuries include cortical microinfarcts, lacunes, and white matter changes.

Purpose of the Study:

  • To review the cognitive impact of various small vessel-related ischemic brain injuries in old age.
  • To focus on microvascular lesions often missed by current neuroimaging.
  • To analyze clinicopathological data on microvascular lesions and AD pathology in different age groups.

Main Methods:

  • Literature review of in vivo data on white matter demyelination and lacunes.
  • Clinicopathological studies of individuals with microvascular lesions and AD pathology.
  • Analysis of autopsy datasets across younger old (65-85) and oldest old (nonagenarians/centenarians) populations.

Main Results:

  • Cortical microinfarcts were identified as the sole consistent determinant of cognitive decline.
  • This finding holds true across the spectrum from purely vascular cases to those with combined vascular and AD pathology.
  • The study highlights the significance of microinfarcts often undetected by routine clinical neuroimaging.

Conclusions:

  • Cortical microinfarcts are a critical factor in age-related cognitive decline.
  • Understanding these lesions is crucial for diagnosing and managing cognitive impairment in the elderly.
  • Further research into sub-types of microvascular lesions is warranted.

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