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BMC Med. 2016 Aug 26;14(1):129. doi: 10.1186/s12916-016-0676-5.

Post-mortem assessment in vascular dementia: advances and aspirations.

Author information

1
Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
2
Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
3
Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA.
4
Stroke Research Team, University Hospital Lille, Lille, France.
5
Departments of neurology and Pathology, University of California, San Francisco, USA.
6
Department of Pathology - LIM-22, University of Sao Paulo Medical School, São Paulo, Brazil.
7
Institute of Cardiovascular and Cell Sciences, St George's University of London, London, UK.
8
Department of Neuropathology, University of Debrecen, Debrecen, Hungary.
9
Sheffield Institute for Translational Neuroscience, Sheffield, UK.
10
Institute of Clinical Neurobiology, Vienna, Austria.
11
Neurological Department, Peking Union Medical College Hospital, Beijing, China.
12
Institute of Neurology, Medical University of Vienna, Vienna, Austria.
13
Department of Mental Health and Psychiatry, University of Geneva, Geneva, Switzerland.
14
Clincial Neurosciences, University of Bristol, Bristol, UK.
15
Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
16
Unit of Neuropathology, Centro Hospitalar do Porto, University of Porto, Porto, Portugal.
17
Department of Neuroscience, KU-Leuven and Department of Pathology, UZ-Leuven, Leuven, Belgium.
18
Institute of Neurology, University College London, London, UK.
19
Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK. Johannes.Attems@ncl.ac.uk.

Abstract

BACKGROUND:

Cerebrovascular lesions are a frequent finding in the elderly population. However, the impact of these lesions on cognitive performance, the prevalence of vascular dementia, and the pathophysiology behind characteristic in vivo imaging findings are subject to controversy. Moreover, there are no standardised criteria for the neuropathological assessment of cerebrovascular disease or its related lesions in human post-mortem brains, and conventional histological techniques may indeed be insufficient to fully reflect the consequences of cerebrovascular disease.

DISCUSSION:

Here, we review and discuss both the neuropathological and in vivo imaging characteristics of cerebrovascular disease, prevalence rates of vascular dementia, and clinico-pathological correlations. We also discuss the frequent comorbidity of cerebrovascular pathology and Alzheimer's disease pathology, as well as the difficult and controversial issue of clinically differentiating between Alzheimer's disease, vascular dementia and mixed Alzheimer's disease/vascular dementia. Finally, we consider additional novel approaches to complement and enhance current post-mortem assessment of cerebral human tissue.

CONCLUSION:

Elucidation of the pathophysiology of cerebrovascular disease, clarification of characteristic findings of in vivo imaging and knowledge about the impact of combined pathologies are needed to improve the diagnostic accuracy of clinical diagnoses.

KEYWORDS:

Cerebrovascular disease; Cerebrovascular lesions; Magnetic resonance imaging; Mixed dementia; Neuropathology; Post-mortem MRI; Vascular cognitive impairment; Vascular dementia

PMID:
27600683
PMCID:
PMC5011905
DOI:
10.1186/s12916-016-0676-5
[Indexed for MEDLINE]
Free PMC Article

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