The need to unify neuropathological assessments of vascular alterations in the ageing brain: multicentre survey by the BrainNet Europe consortium.
Here, we summarise the results after carrying out a large survey regarding the assessment of vascular alterations, both vessel changes and vascular lesions in an inter-laboratory setting. In total, 32 neuropathologists from 22 centres, most being members of BrainNet Europe (BNE), participated by filling out a questionnaire with emphasis on assessment of common vascular alterations seen in the brains of aged subjects. A certain level of harmonisation has been reached among BNE members regarding sectioning of the brain, harvesting of brain tissue for histology and staining used when compared to the survey carried out in 2006 by Pantoni and colleagues. The most significant variability was seen regarding the assessment of severity and of clinical significance of vascular alterations. Two strategies have recently been recommended regarding the assessment of vascular alterations in aged and demented subjects. The National Institute on Aging - Alzheimer's Association (NIA-AA) recommends the assessment of hippocampal sclerosis, vascular brain injury and microvascular lesions in 12 regions. Although this strategy will be easy to follow, the recommendations do not inform how the load of observed alterations should be assessed and when the observed lesions are of significance. Deramecourt and his colleagues recommend an assessment and semiquantitative grading of various pathologies in 4 brain regions. This strategy yielded a total score of 0 to 20 as an estimate of pathology load. It is, however, not clear which score is considered to be of clinical significance. Furthermore, in several BNE trials the semiquantitative assessment has yielded poor agreement rates; an observation that might negatively influence the strategy proposed by Deramecourt and his colleagues. In line with NIA-AA, a dichotomised approach of easily recognisable lesions in a standardised set of brain regions harvested for neuropathological assessment and applying reproducible sampling and staining strategies is recommended by BNE. However, a simple strategy regarding assessment of load of alteration is urgently needed to yield reproducible, and at the same time, comparable results between centres.
Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden. Irina.Alafuzoff@igp.uu.se
Irina
I
Alafuzoff
Ellen
E
Gelpi
Safa
S
Al-Sarraj
Thomas
T
Arzberger
Johannes
J
Attems
Istvan
I
Bodi
Nenad
N
Bogdanovic
Herbert
H
Budka
Orso
O
Bugiani
Elisabet
E
Englund
Isidro
I
Ferrer
Stephen
S
Gentleman
Giorgio
G
Giaccone
Manuel B
MB
Graeber
Tibor
T
Hortobagyi
Romana
R
Höftberger
James W
JW
Ironside
Kurt
K
Jellinger
Nikolaos
N
Kavantzas
Andrew
A
King
Penelope
P
Korkolopoulou
Gábor G
GG
Kovács
David
D
Meyronet
Camelia
C
Monoranu
Piero
P
Parchi
Efstratios
E
Patsouris
Wolfgang
W
Roggendorf
Annemieke
A
Rozemuller
Danielle
D
Seilhean
Nathalie
N
Streichenberger
Dietmar R
DR
Thal
Stephen B
SB
Wharton
Hans
H
Kretzschmar
D000375:Aging / Q000502:physiology*; D001921:Brain / Q000098:blood supply*; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000503:physiopathology*; D003704:Dementia / Q000503:physiopathology*; D006801:Humans; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013048:Specimen Handling; D013194:Staining and Labeling / Q000379:methods / Q000592:standards; D011795:Surveys and Questionnaires