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White matter changes in dementia: role of impaired drainage of interstitial fluid

Roy O Weller1, Cheryl A Hawkes, Raj N Kalaria

  • 1Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.

Brain Pathology (Zurich, Switzerland)
|December 19, 2014
PubMed

Insights

Impaired lymphatic drainage in the aging brain contributes to white matter hyperintensities (WMH) and Alzheimer's disease. Enhancing this drainage may prevent these conditions and improve dementia treatment.

Area of Science:

  • Neuroscience
  • Radiology
  • Pathology

Background:

  • White matter abnormalities, including white matter hyperintensities (WMH) and visible perivascular spaces (PVS), are linked to dementia.
  • These abnormalities involve fluid accumulation and expansion of extracellular spaces in the brain's white matter.

Purpose of the Study:

  • To review the role of impaired interstitial fluid drainage in the development of WMH and PVS.
  • To explore the impact of aging and genetic factors on brain lymphatic drainage.

Main Methods:

  • Review of existing literature on brain fluid dynamics and white matter pathology.
  • Analysis of the relationship between aging, apolipoprotein E ε4, and lymphatic drainage impairment.
  • Examination of protein deposition in cerebral vasculature as a cause of impaired drainage.

Main Results:

  • Brain lymphatic drainage, crucial for fluid and solute removal, is impaired with age and associated with Alzheimer's disease risk factors.
  • Impaired drainage, termed protein elimination failure angiopathy (PEFA), contributes to conditions like cerebral amyloid angiopathy (CAA) and WMH.
  • Age-related protein deposition in cerebral arteries hinders lymphatic clearance.

Conclusions:

  • Facilitating perivascular lymphatic drainage in the aging brain could be key to preventing CAA, WMH, and Alzheimer's disease.
  • Improving lymphatic function may enhance the effectiveness of Alzheimer's disease immunotherapies.
Keywords:
Alzheimer's diseaseCADASILamyloid-βcerebral amyloid angiopathyperivascular drainageperivascular spacesprotein elimination failure angiopathy (PEFA)white matter hyperintensities

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