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Neuropathol Appl Neurobiol. 2019 Aug 6. doi: 10.1111/nan.12576. [Epub ahead of print]

The spectrum of age-related small vessel diseases: potential overlap and interactions of amyloid and non-amyloid vasculopathies.

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Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.
German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany.
Department of Neuropathology, Otto-von-Guericke University, Magdeburg, Germany.
Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.


Deep perforator arteriopathy (DPA) and cerebral amyloid angiopathy (CAA) are the commonest known cerebral small vessel diseases (CSVD), which cause ischaemic stroke, intracebral haemorrhage (ICH) and vascular cognitive impairment (VCI). While thus far mainly considered as separate entities, we here propose that DPA and CAA share similarities, overlap and interact, so that "pure" DPA or CAA are extremes along a continuum of age-related small vessel pathologies. We suggest blood-brain barrier (BBB) breakdown, endothelial damage and impaired perivascular β-amyloid (Aβ) drainage are hallmark common mechanisms connecting DPA and CAA. We also suggest a need for new biomarkers (e.g. high-resolution imaging) to deepen understanding of the complex relationships between DPA and CAA. This article is protected by copyright. All rights reserved.


Cerebral small vessel diseases; blood-brain barrier; cerebral amyloid angiopathy; cerebrospinal fluid; deep perforator arteriopathy; hypertensive arteriopathy; imaging; positron emission tomography; β-amyloid drainage


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