Defining the Neuropathological Background of Vascular and Mixed Dementia and Comparison with Magnetic Resonance Imaging FindingsGold G.
Department of Geriatrics and Rehabilitation, Geneva University School of Medicine and Geneva University Hospitals, Thônex, Geneva, Switzerland
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The concept of vascular dementia (VaD) has greatly evolved in the past decades. Advances in neuroimagingtechniques have led to a better identification of cases with small vessel disease andchronic ischemic changes. Autopsy data from population-based studies have revealed the frequentoccurrence of both vascular and degenerative lesions in aged brains. However, the clinical significanceof vascular pathology has been difficult to establish. This chapter will review data from clinicoradiologicaland clinicopathological studies that have attempted to define the cognitive impact ofmacroscopic and microscopic ischemic pathology in pure VaD and in cases with associated degenerativepathology. Magnetic resonance imaging studies have focused on lacunes and white matterlesions, whereas autopsy series have provide important insights into the clinical correlates of macroinfarcts,lacunes, diffuse and periventricular demyelination, microinfarcts and focal and diffuse gliosis.Results from these studies have led to a better understanding of the influence of lesion type,location and severity on cognitive function. Vascular scores have been proposed that can be combinedwith well-established classifications of Alzheimer’s disease (AD) pathology to distinguishmixed dementias from pure AD and pure VaD.
© 2009 S. Karger AG, Basel
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