Neuropathological assessment of the lesions of significance in vascular dementia
Neuropathological assessment of the lesions of significance in vascular dementia
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DOI：
10.1136/jnnp.63.6.749
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发表时间：
1997-12-01
影响因子：
11
通讯作者：
Morris, JH
中科院分区：
文献类型：
--
作者：
Esiri, MM;Wilcock, GK;Morris, JH
目的更好地界定血管性痴呆的神经病理学。方法：将18名无脑血管疾病的老年痴呆患者的神经病理学结果与19名患有脑血管疾病的老年痴呆患者（其中许多人曾“中风”）和24名患有脑血管疾病但没有其他病理解释痴呆的老年痴呆患者进行比较。所有组的病例均为不存在或不超过非常轻微的阿尔茨海默病型病理。结果：以严重筛状改变为形式的微血管脑损伤及其相关的皮层下白质损伤和微梗死与痴呆史相关。伴有血管疾病的痴呆组较未伴有血管疾病的痴呆组更常见严重筛状改变，微梗死更常见（P=0.0006和P=0.031）。其他值得注意的发现是，嗜血性血管病在血管性痴呆组的患病率高于对照组，单一脑梗死在无血管性痴呆组比痴呆和血管性疾病组更常见（P=0.0028），最后一组比第一组更缺乏宏观梗死的证据（P=0.034）。痴呆合并血管性疾病组的一个大脑半球的梗死组织和未梗死组织的比率高于血管性疾病但无痴呆的组，这一趋势不显著。结论：在这一系列病例中，微血管病变是血管性痴呆的主要基础，而非宏观梗死。
Objectives-To better define the neuropathology of vascular dementia.Methods-The neuropathological findings in 18 elderly, undemented subjects free of cerebrovascular disease were compared with 19 elderly undemented subjects who had cerebrovascular disease (many of whom had had a "stroke") and 24 elderly demented subjects who had cerebrovascular disease, but no other pathology to account for dementia. Cases in all groups were selected for absence or no more than very mild Alzheimer type pathology.Results-Microvascular brain damage in the form of severe cribriform change and associated subcortical white matter damage and microinfarction were correlated with a history of dementia. Severe cribriform change was much more common and microinfarction somewhat more common in the demented group with vascular disease than the undemented group with vascular disease (P=0.0006 and P=0.031 respectively). Other findings of note were that congophilic angiopathy had a greater prevalence in the vascular dementia group than the control group, single cerebral infarcts were more common in the group who were undemented with vascular disease than in the group with dementia and vascular disease (P=0.0028), and the last group lacked evidence of macroscopic infarction more often than the first (P=0.034). There was a non-significant trend for the ratio of infarcted:uninfarcted tissue in one cerebral hemisphere to be higher in the group with dementia and vascular disease than in the group with vascular disease but no demenda.Conclusions-Microvascular disease, not macroscopic infarction, was the chief substrate of vascular dementia in this series of cases.