Diffuse vacuolization (spongiosis) and arteriolosclerosis in the frontal white matter occurs in vascular dementia
T. Erkinjuntti, O. Benavente, M. Eliasziw, D. G. Munoz, R. Sulkava, M. Haltia and V. Hachinski
Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada.
OBJECTIVE: To examine quantitatively white-matter changes at different
sites in patients with definite vascular dementia and Alzheimer's disease.
DESIGN: Prospective clinical and neuropathological series. SETTING:
University Hospital clinics (Helsinki, Finland and London, Ontario).
SUBJECTS: Twenty-two patients with a clinical and neuropathological
diagnosis of vascular dementia and 20 patients with Alzheimer's disease.
MEASURES: The frequencies of focal white-matter lesions,
arteriolosclerosis, and cerebral amyloid angiopathy were assessed.
Validated ratings and cell counts were done in the subcortical U-fiber,
centrum semiovale, and periventricular areas of the frontal white matter.
Degrees of abnormality (none, mild, moderate, severe) were rated for
spongiosis (vacuolization of white matter), etat crible (widening of
perivascular spaces), myelin loss, oligodendrocyte density, axonal loss,
and overall. Densities of oligodendrocytes and astrocytes (cells per square
millimeter) were determined. RESULTS: Patients with vascular dementia
showed focal white-matter lesions and arteriolosclerosis more often than
patients with Alzheimer's disease. The patients with vascular dementia also
had significantly greater spongiosis (P<.001), etat crible (P=.004),
myelin loss (P<.005) and overall white-matter abnormality (P<.001).
Arteriolosclerosis was found in association with spongiosis but not with
etat crible. Cerebral amyloid angiopathy did not appear to be related to
any of the white-matter changes in patients with either vascular dementia
or Alzheimer's disease. The U-fiber area showed fewer changes, and the
periventricular area tended to be most affected. CONCLUSION: In addition to
focal infarcts, patients with vascular dementia showed widespread diffuse
changes, including spongiosis and arteriolosclerosis, along with etat
crible and myelin loss. White-matter changes in patients with Alzheimer's
disease could not be related to infarction. Pathologic changes in small
blood vessels are associated with diffuse white-matter changes and may have
a distinct role in the genesis of vascular dementia.
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