Neuropathological assessment of the lesions of significance invascular dementia

OBJECTIVES—To better define the neuropathology ofvascular dementia.
METHODS—The neuropathological findings in 18 elderly, undemented subjects free of cerebrovascular disease werecompared with 19 elderly undemented subjects who had cerebrovasculardisease (many of whom had had a "stroke") and 24 elderly dementedsubjects who had cerebrovascular disease, but no other pathology toaccount for dementia. Cases in all groups were selected for absence orno more than very mild Alzheimer type pathology.
RESULTS—Microvascular brain damage in the form ofsevere cribriform change and associated subcortical white matter damageand microinfarction were correlated with a history of dementia. Severecribriform change was much more common and microinfarction somewhatmore common in the demented group with vascular disease than theundemented group with vascular disease (P=0.0006 and P=0.031respectively). Other findings of note were that congophilic angiopathyhad a greater prevalence in the vascular dementia group than thecontrol 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 ofinfarcted:uninfarcted tissue in one cerebral hemisphere to be higher inthe group with dementia and vascular disease than in the group withvascular disease but no dementia.
CONCLUSIONS—Microvascular disease, not macroscopicinfarction, was the chief substrate of vascular dementia in this seriesof cases.