Post-mortem assessment in vascular dementia: advances and aspirations

BMC Medicine

Opinion

Seth Love¹  Olivia Skrobot¹  Irina Alafuzoff²  Enikö Kövari³  Tibor Hortobagyi⁴  Dietmar R. Thal⁵  Lea T. Grinberg⁶  Andreas Charidimou⁷  Atticus H. Hainsworth⁸  Kurt Jellinger⁹  Gabor G. Kovacs^1,10  David Werring^1,11  Johannes Attems^1,12  Kirsty E. McAleese^1,12  Raj N. Kalaria^1,12  Mara Popovic^1,13  Jing Gao^1,14  Stephen B. Wharton^1,15  Paul Ince^1,15  Jacques De Reuck^1,16  Ricardo Taipa^1,17 

[1] Clincial Neurosciences, University of Bristol, Bristol, UK;Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden;Department of Mental Health and Psychiatry, University of Geneva, Geneva, Switzerland;Department of Neuropathology, University of Debrecen, Debrecen, Hungary;Department of Neuroscience, KU-Leuven and Department of Pathology, UZ-Leuven, Leuven, Belgium;Departments of neurology and Pathology, University of California, San Francisco, USA;Department of Pathology – LIM-22, University of Sao Paulo Medical School, São Paulo, Brazil;Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA;Institute of Cardiovascular and Cell Sciences, St George’s University of London, London, UK;Institute of Clinical Neurobiology, Vienna, Austria;Institute of Neurology, Medical University of Vienna, Vienna, Austria;Institute of Neurology, University College London, London, UK;Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK;Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia;Neurological Department, Peking Union Medical College Hospital, Beijing, China;Sheffield Institute for Translational Neuroscience, Sheffield, UK;Stroke Research Team, University Hospital Lille, Lille, France;Unit of Neuropathology, Centro Hospitalar do Porto, University of Porto, Porto, Portugal;

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

DOI  :  10.1186/s12916-016-0676-5

 received in 2016-05-28, accepted in 2016-08-19,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundCerebrovascular 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.DiscussionHere, 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.ConclusionElucidation 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.

【 授权许可】

CC BY   
© The Author(s). 2016