Post-mortem assessment in vascular dementia: advances and aspirations.
Cerebrovascular 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.



Here, 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.



Elucidation 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.
Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
Kirsty E
KE
McAleese
Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
Irina
I
Alafuzoff
Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA.
Andreas
A
Charidimou
Stroke Research Team, University Hospital Lille, Lille, France.
Jacques
J
De Reuck
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.
Lea T
LT
Grinberg
Institute of Cardiovascular and Cell Sciences, St George's University of London, London, UK.
Atticus H
AH
Hainsworth
Department of Neuropathology, University of Debrecen, Debrecen, Hungary.
Tibor
T
Hortobagyi
Sheffield Institute for Translational Neuroscience, Sheffield, UK.
Paul
P
Ince
Institute of Clinical Neurobiology, Vienna, Austria.
Kurt
K
Jellinger
Neurological Department, Peking Union Medical College Hospital, Beijing, China.
Jing
J
Gao
Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
Raj N
RN
Kalaria
Institute of Neurology, Medical University of Vienna, Vienna, Austria.
Gabor G
GG
Kovacs
Department of Mental Health and Psychiatry, University of Geneva, Geneva, Switzerland.
Enikö
E
Kövari
Clincial Neurosciences, University of Bristol, Bristol, UK.
Seth
S
Love
Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Mara
M
Popovic
Clincial Neurosciences, University of Bristol, Bristol, UK.
Olivia
O
Skrobot
Unit of Neuropathology, Centro Hospitalar do Porto, University of Porto, Porto, Portugal.
Ricardo
R
Taipa
Department of Neuroscience, KU-Leuven and Department of Pathology, UZ-Leuven, Leuven, Belgium.
Dietmar R
DR
Thal
Institute of Neurology, University College London, London, UK.
David
D
Werring
Sheffield Institute for Translational Neuroscience, Sheffield, UK.
Stephen B
SB
Wharton
Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK. Johannes.Attems@ncl.ac.uk.
Johannes
J
Attems
D000368:Aged; D000544:Alzheimer Disease / Q000453:epidemiology / Q000473:pathology; D001344:Autopsy; D001921:Brain / Q000473:pathology*; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000473:pathology; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology / Q000473:pathology; D015140:Dementia, Vascular / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D015995:Prevalence
Cerebrovascular disease; Cerebrovascular lesions; Magnetic resonance imaging; Mixed dementia; Neuropathology; Post-mortem MRI; Vascular cognitive impairment; Vascular dementia