Vascular dementia: current concepts and nomenclature harmonization

Grinberg, Lea Tenenholz

doi:10.1590/S1980-57642012DN06030002

ABSTRACT

Several types of cerebrovascular lesions are associated with cognitive decline, but the role of each type in dementia manifestation has yet to be determined. One of the greatest barriers of conducting clinicopathological studies in vascular dementia concerns the overlapping of nomenclature for these lesions. The aim of the present review was to discuss current nomenclature for cerebrovascular lesions and suggest modifications to allow better diagnostic reproducibility in this field

Key words:
pathology; Alzheimer's disease; cerebrovascular diseases; vascular dementia

RESUMO

Diversas lesões cerebrovasculares estão associadas à perda cognitiva. Entretanto ainda não se conhece qual a contribuição exata dessas lesões para quadros os demenciais. Um dos maiores empecilhos para estudos de correlação clinico patológica em demências vasculares é a heteregeonidade de termos usados para definir essas lesões. A presente revisão discute a nomenclatura neuropatológica atual para lesões cerebrovasculares e sugere alternativas para melhorar a acurácia e reprodutividade do diagnóstico das mesmas.

Palavras-chave:
patologia; doença de Alzheimer; demência vascular; doenças cerebrovasculares

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REFERENCES

Roman GC, Sachdev P, Royall DR, et al. Vascular cognitive disorder: a new diagnostic category updating vascular cognitive impairment and vascular dementia. J Neurol Sci 2004;226:81-87.
Grinberg LT, Heinsen H. Toward a pathological definition of vascular dementia. J Neurol Sci 2010;299:136-138.
Korczyn AD, Vakhapova V. The prevention of the dementia epidemic. J Neurol Sci 2007;257:2-4.
Schneider JA, Arvanitakis Z, Bang W, Bennett DA. Mixed brain pathologies account for most dementia cases in community-dwelling older persons. Neurology 2007;69:2197-2204.
Korczyn AD. Mixed dementia--the most common cause of dementia. Ann N Y Acad Sci 2002;977:129-134.
Korczyn AD. The complex nosological concept of vascular dementia. J Neurol Sci 2002;203-204:3-6.
Langa KM, Foster NL, Larson EB. Mixed dementia: emerging concepts and therapeutic implications. JAMA 2004;292:2901-2908.
Iadecola C. Neurovascular regulation in the normal brain and in Alzheimer's disease. Nat Rev Neurosci 2004;5:347-360.
Grinberg LT, Thal DR. Vascular pathology in the aged human brain. Acta Neuropathol 2010;119:277-290.
Ferrer I. Cognitive impairment of vascular origin: neuropathology of cognitive impairment of vascular origin. J Neurol Sci 2010;299:139-149.
Gorelick PB, Scuteri A, Black SE, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association. Stroke 2011;42:2672-2713.
Hachinski V, Iadecola C, Petersen RC, et al. National Institute of Neurological Disorders and Stroke -Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke 2006;37:2220-2241.
Kalaria RN. Dementia comes of age in the developing world. Lancet 2003;361:888-9.
Roman GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia - diagnostic criteria for research studies - report of the NINDS-AIREN international workshop. Neurology 1993;43:250-260.
Kolsch H, Larionov S, Dedeck O, et al. Association of the glutathione S-transferase omega-1 Ala140Asp polymorphism with cerebrovascular atherosclerosis and plaque-associated interleukin-1 alpha expression. Stroke 2007;38:2847-2850.
Larionov S, Dedeck O, Birkenmeier G, Thal DR. Expression of alpha2-macroglobulin, neutrophil elastase, and interleukin-1alpha differs in early-stage and late-stage atherosclerotic lesions in the arteries of the circle of Willis. Acta Neuropathol 2007;113:33-43.
Liberato B, Chong JY, Sacco RL. Focal brain ischemia. Clinical features, epidemiology, risk factors and outcome. In: Kalimo H, ed. Cerebrovascular Diseases. Basel: ISN Neuropath Press; 2005.
Jellinger KA. The enigma of vascular cognitive disorder and vascular dementia. Acta Neuropathol 2007;113:349-388.
Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 2010;9:689-701.
Lammie AG. Small vessel disease. . In: Kalimo H, ed. Cerebrovascular Diseases. Basel: ISN Neuropath Press ; 2005: 85-91.
Utter S, Tamboli IY, Walter J, et al. Cerebral small vessel disease-induced apolipoprotein E leakage is associated with Alzheimer disease and the accumulation of amyloid beta-protein in perivascular astrocytes. J Neuropathol Exp Neurol 2008;67:842-856.
Lammie GA. Hypertensive cerebral small vessel disease and stroke. Brain Pathol 2002;12:358-370.
Simpson JE, Wharton SB, Cooper J, et al. Alterations of the blood-brain barrier in cerebral white matter lesions in the ageing brain. Neurosci Lett 2010;486:246-51.
Thal DR, Ghebremedhin E, Orantes M, Wiestler OD. Vascular pathology in Alzheimer disease: correlation of cerebral amyloid angiopathy and arteriosclerosis/lipohyalinosis with cognitive decline. J Neuropathol Exp Neurol 2003;62:1287-1301.
Takao M, Koto A, Tanahashi N, Fukuuchi Y, Takagi M, Morinaga S. Pathologic findings of silent, small hyperintense foci in the basal ganglia and thalamus on MRI. Neurology 1999;52:666-668.
Fazekas F, Kleinert R, Offenbacher H, et al. Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurology 1993;43:1683-1689.
Leys D, Pruvo JP, Parent M, et al. Could Wallerian degeneration contribute to "leuko-araiosis" in subjects free of any vascular disorder? J Neurol Neurosurg Psychiatry 1991;54:46-50.
Vonsattel JP, Myers RH, Hedley-Whyte ET, Ropper AH, Bird ED, Richardson EP Jr. Cerebral amyloid angiopathy without and with cerebral hemorrhages: a comparative histological study. Ann Neurol 1991;30:637-649.
Wisniewski HM, Wegiel J, Wang KC, Lach B. Ultrastructural studies of the cells forming amyloid in the cortical vessel wall in Alzheimer's disease. Acta Neuropathol 1992;84:117-127.
Greenberg SM, Nandigam RN, Delgado P, et al. Microbleeds versus macrobleeds: evidence for distinct entities. Stroke 2009;40:2382-2386.
Thal DR, Capetillo-Zarate E, Larionov S, Staufenbiel M, Zurbruegg S, Beckmann N. Capillary cerebral amyloid angiopathy is associated with vessel occlusion and cerebral blood flow disturbances. Neurobiol Aging 2009;30:1936-1948.
Cadavid D, Mena H, Koeller K, Frommelt RA. Cerebral beta amyloid angiopathy is a risk factor for cerebral ischemic infarction. A case control study in human brain biopsies. J Neuropathol Exp Neurol 2000;59:768-773.
Hoffmann M, Schmitt F, Bromley E. Vascular cognitive syndromes: relation to stroke etiology and topography. Acta Neurol Scand 2009;120: 161-169.
Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol 2009;8:1006-1018.
Koga H, Takashima Y, Murakawa R, Uchino A, Yuzuriha T, Yao H. Cognitive consequences of multiple lacunes and leukoaraiosis as vascular cognitive impairment in community-dwelling elderly individuals. J Stroke Cerebrovasc Dis 2009;18:32-37.
Jellinger KA. A critical evaluation of current staging of alpha-synuclein pathology in Lewy body disorders. Biochim Biophys Acta 2009;1792: 730-740.
Kalaria RN, Kenny RA, Ballard CG, Perry R, Ince P, Polvikoski T. Towards defining the neuropathological substrates of vascular dementia. J Neurol Sci 2004;226:75-80.
Gerraty RP, Parsons MW, Barber PA, et al. Examining the lacunar hypothesis with diffusion and perfusion magnetic resonance imaging. Stroke 2002;33:2019-2024.
Okamoto Y, Ihara M, Fujita Y, Ito H, Takahashi R, Tomimoto H. Cortical microinfarcts in Alzheimer's disease and subcortical vascular dementia. Neuroreport 2009;20:990-996.
Kovari E, Gold G, Herrmann FR, et al. Cortical microinfarcts and demyelination affect cognition in cases at high risk for dementia. Neurology 2007;68:927-931.
Jellinger KA. Understanding the pathology of vascular cognitive impairment. J Neurol Sci 2005;229-230:57-63.
Probst A, Taylor KI, Tolnay M. Hippocampal sclerosis dementia: a reappraisal. Acta Neuropathol 2007;114:335-345.
Brown WR, Moody DM, Thore CR, Anstrom JA, Challa VR. Microvascular changes in the white mater in dementia. J Neurol Sci 2009;283:28-31.
Binswanger O. Die Abgrenzung der allgemeinen progressiven Paralyse. Berl Klin Wochenschr 1894;31:1102-1105.
Yamori Y, Horie R, Handa H, Sato M, Fukase M. Pathogenetic similarity of strokes in stroke-prone spontaneously hypertensive rats and humans. Stroke 1976;7:46-53.
Bonni A, Sun Y, Nadalvicens M, et al. Regulation of gliogenesis in the central nervous system by the JAK-STAT signaling pathway. Science 1997;278:477-483.
Mandybur TI. Cerebral amyloid angiopathy: the vascular pathology and complications. J Neuropathol Exp Neurol 1986;45:79-90.
Thal DR, Griffin WS, de Vos RA, Ghebremedhin E. Cerebral amyloid angiopathy and its relationship to Alzheimer's disease. Acta Neuropathol 2008;115:599-609.
Henry-Feugeas MC. MRI of the 'Alzheimer syndrome'. J Neuroradiol 2007;34:220-227.
Tsushima Y, Aoki J, Endo K. Brain microhemorrhages detected on T2*-weighted gradient-echo MR images. AmJNeuroradiol 2003;24:88-96.
De Reuck J, Auger F, Cordonnier C, et al. Comparison of 7.0-T T*-magnetic resonance imaging of cerebral bleeds in post-mortem brain sections of Alzheimer patients with their neuropathological correlates. Cerebrovasc Dis 2011;31:511-517.
Hommet C, Mondon K, Constans T, et al. Review of cerebral microangiopathy and Alzheimer's disease: relation between white matter hyperintensities and microbleeds. Dement Geriatr Cogn Disord 2011;32:367-378.

Publication Dates

Publication in this collection
Jul-Sep 2012

History

Received
20 June 2012
Accepted
20 Aug 2012

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Roman GC, Sachdev P, Royall DR, et al. Vascular cognitive disorder: a new diagnostic category updating vascular cognitive impairment and vascular dementia. J Neurol Sci 2004;226:81-87.

[2] Grinberg LT, Heinsen H. Toward a pathological definition of vascular dementia. J Neurol Sci 2010;299:136-138.

[3] Korczyn AD, Vakhapova V. The prevention of the dementia epidemic. J Neurol Sci 2007;257:2-4.

[4] Schneider JA, Arvanitakis Z, Bang W, Bennett DA. Mixed brain pathologies account for most dementia cases in community-dwelling older persons. Neurology 2007;69:2197-2204.

[5] Korczyn AD. Mixed dementia--the most common cause of dementia. Ann N Y Acad Sci 2002;977:129-134.

[6] Korczyn AD. The complex nosological concept of vascular dementia. J Neurol Sci 2002;203-204:3-6.

[7] Langa KM, Foster NL, Larson EB. Mixed dementia: emerging concepts and therapeutic implications. JAMA 2004;292:2901-2908.

[8] Iadecola C. Neurovascular regulation in the normal brain and in Alzheimer's disease. Nat Rev Neurosci 2004;5:347-360.

[9] Grinberg LT, Thal DR. Vascular pathology in the aged human brain. Acta Neuropathol 2010;119:277-290.

[10] Ferrer I. Cognitive impairment of vascular origin: neuropathology of cognitive impairment of vascular origin. J Neurol Sci 2010;299:139-149.

[11] Gorelick PB, Scuteri A, Black SE, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association. Stroke 2011;42:2672-2713.

[12] Hachinski V, Iadecola C, Petersen RC, et al. National Institute of Neurological Disorders and Stroke -Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke 2006;37:2220-2241.

[13] Kalaria RN. Dementia comes of age in the developing world. Lancet 2003;361:888-9.

[14] Roman GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia - diagnostic criteria for research studies - report of the NINDS-AIREN international workshop. Neurology 1993;43:250-260.

[15] Kolsch H, Larionov S, Dedeck O, et al. Association of the glutathione S-transferase omega-1 Ala140Asp polymorphism with cerebrovascular atherosclerosis and plaque-associated interleukin-1 alpha expression. Stroke 2007;38:2847-2850.

[16] Larionov S, Dedeck O, Birkenmeier G, Thal DR. Expression of alpha2-macroglobulin, neutrophil elastase, and interleukin-1alpha differs in early-stage and late-stage atherosclerotic lesions in the arteries of the circle of Willis. Acta Neuropathol 2007;113:33-43.

[17] Liberato B, Chong JY, Sacco RL. Focal brain ischemia. Clinical features, epidemiology, risk factors and outcome. In: Kalimo H, ed. Cerebrovascular Diseases. Basel: ISN Neuropath Press; 2005.

[18] Jellinger KA. The enigma of vascular cognitive disorder and vascular dementia. Acta Neuropathol 2007;113:349-388.

[19] Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 2010;9:689-701.

[20] Lammie AG. Small vessel disease. . In: Kalimo H, ed. Cerebrovascular Diseases. Basel: ISN Neuropath Press ; 2005: 85-91.

[21] Utter S, Tamboli IY, Walter J, et al. Cerebral small vessel disease-induced apolipoprotein E leakage is associated with Alzheimer disease and the accumulation of amyloid beta-protein in perivascular astrocytes. J Neuropathol Exp Neurol 2008;67:842-856.

[22] Lammie GA. Hypertensive cerebral small vessel disease and stroke. Brain Pathol 2002;12:358-370.

[23] Simpson JE, Wharton SB, Cooper J, et al. Alterations of the blood-brain barrier in cerebral white matter lesions in the ageing brain. Neurosci Lett 2010;486:246-51.

[24] Thal DR, Ghebremedhin E, Orantes M, Wiestler OD. Vascular pathology in Alzheimer disease: correlation of cerebral amyloid angiopathy and arteriosclerosis/lipohyalinosis with cognitive decline. J Neuropathol Exp Neurol 2003;62:1287-1301.

[25] Takao M, Koto A, Tanahashi N, Fukuuchi Y, Takagi M, Morinaga S. Pathologic findings of silent, small hyperintense foci in the basal ganglia and thalamus on MRI. Neurology 1999;52:666-668.

[26] Fazekas F, Kleinert R, Offenbacher H, et al. Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurology 1993;43:1683-1689.

[27] Leys D, Pruvo JP, Parent M, et al. Could Wallerian degeneration contribute to "leuko-araiosis" in subjects free of any vascular disorder? J Neurol Neurosurg Psychiatry 1991;54:46-50.

[28] Vonsattel JP, Myers RH, Hedley-Whyte ET, Ropper AH, Bird ED, Richardson EP Jr. Cerebral amyloid angiopathy without and with cerebral hemorrhages: a comparative histological study. Ann Neurol 1991;30:637-649.

[29] Wisniewski HM, Wegiel J, Wang KC, Lach B. Ultrastructural studies of the cells forming amyloid in the cortical vessel wall in Alzheimer's disease. Acta Neuropathol 1992;84:117-127.

[30] Greenberg SM, Nandigam RN, Delgado P, et al. Microbleeds versus macrobleeds: evidence for distinct entities. Stroke 2009;40:2382-2386.

[31] Thal DR, Capetillo-Zarate E, Larionov S, Staufenbiel M, Zurbruegg S, Beckmann N. Capillary cerebral amyloid angiopathy is associated with vessel occlusion and cerebral blood flow disturbances. Neurobiol Aging 2009;30:1936-1948.

[32] Cadavid D, Mena H, Koeller K, Frommelt RA. Cerebral beta amyloid angiopathy is a risk factor for cerebral ischemic infarction. A case control study in human brain biopsies. J Neuropathol Exp Neurol 2000;59:768-773.

[33] Hoffmann M, Schmitt F, Bromley E. Vascular cognitive syndromes: relation to stroke etiology and topography. Acta Neurol Scand 2009;120: 161-169.

[34] Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol 2009;8:1006-1018.

[35] Koga H, Takashima Y, Murakawa R, Uchino A, Yuzuriha T, Yao H. Cognitive consequences of multiple lacunes and leukoaraiosis as vascular cognitive impairment in community-dwelling elderly individuals. J Stroke Cerebrovasc Dis 2009;18:32-37.

[36] Jellinger KA. A critical evaluation of current staging of alpha-synuclein pathology in Lewy body disorders. Biochim Biophys Acta 2009;1792: 730-740.

[37] Kalaria RN, Kenny RA, Ballard CG, Perry R, Ince P, Polvikoski T. Towards defining the neuropathological substrates of vascular dementia. J Neurol Sci 2004;226:75-80.

[38] Gerraty RP, Parsons MW, Barber PA, et al. Examining the lacunar hypothesis with diffusion and perfusion magnetic resonance imaging. Stroke 2002;33:2019-2024.

[39] Okamoto Y, Ihara M, Fujita Y, Ito H, Takahashi R, Tomimoto H. Cortical microinfarcts in Alzheimer's disease and subcortical vascular dementia. Neuroreport 2009;20:990-996.

[40] Kovari E, Gold G, Herrmann FR, et al. Cortical microinfarcts and demyelination affect cognition in cases at high risk for dementia. Neurology 2007;68:927-931.

[41] Jellinger KA. Understanding the pathology of vascular cognitive impairment. J Neurol Sci 2005;229-230:57-63.

[42] Probst A, Taylor KI, Tolnay M. Hippocampal sclerosis dementia: a reappraisal. Acta Neuropathol 2007;114:335-345.

[43] Brown WR, Moody DM, Thore CR, Anstrom JA, Challa VR. Microvascular changes in the white mater in dementia. J Neurol Sci 2009;283:28-31.

[44] Binswanger O. Die Abgrenzung der allgemeinen progressiven Paralyse. Berl Klin Wochenschr 1894;31:1102-1105.

[45] Yamori Y, Horie R, Handa H, Sato M, Fukase M. Pathogenetic similarity of strokes in stroke-prone spontaneously hypertensive rats and humans. Stroke 1976;7:46-53.

[46] Bonni A, Sun Y, Nadalvicens M, et al. Regulation of gliogenesis in the central nervous system by the JAK-STAT signaling pathway. Science 1997;278:477-483.

[47] Mandybur TI. Cerebral amyloid angiopathy: the vascular pathology and complications. J Neuropathol Exp Neurol 1986;45:79-90.

[48] Thal DR, Griffin WS, de Vos RA, Ghebremedhin E. Cerebral amyloid angiopathy and its relationship to Alzheimer's disease. Acta Neuropathol 2008;115:599-609.

[49] Henry-Feugeas MC. MRI of the 'Alzheimer syndrome'. J Neuroradiol 2007;34:220-227.

[50] Tsushima Y, Aoki J, Endo K. Brain microhemorrhages detected on T2*-weighted gradient-echo MR images. AmJNeuroradiol 2003;24:88-96.

[51] De Reuck J, Auger F, Cordonnier C, et al. Comparison of 7.0-T T*-magnetic resonance imaging of cerebral bleeds in post-mortem brain sections of Alzheimer patients with their neuropathological correlates. Cerebrovasc Dis 2011;31:511-517.

[52] Hommet C, Mondon K, Constans T, et al. Review of cerebral microangiopathy and Alzheimer's disease: relation between white matter hyperintensities and microbleeds. Dement Geriatr Cogn Disord 2011;32:367-378.

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