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Diffuse Vacuolization (Spongiosis) and Arteriolosclerosis in the Frontal White Matter Occurs in Vascular Dementia
Timo Erkinjuntti, MD, PhD;
Oscar Benavente, MD;
Michael Eliasziw, PhD;
David G. Munoz, MD;
Raimo Sulkava, MD, PhD;
Matti Haltia, MD, PhD;
Vladimir Hachinski, MD, DSc(Med)
Arch Neurol. 1996;53(4):325-332.
Abstract
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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), état criblé (wideningof 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), état criblé (P=.004), myelin loss (P=.005) and overall white-matter abnormality (P<.001). Arteriolosclerosis was found in association with spongiosis but not with état criblé. 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 état criblé 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.
Author Affiliations
From the Departments of Clinical Neurological Sciences (Drs Erkinjuntti, Benavente, Eliasziw, and Hachinski), Pathology (Dr Munoz), and Epidemiology and Biostatistics (Dr Eliasziw), University of Western Ontario, London; John P. Robarts Research Institute, London, Ontario (Drs Erkinjuntti, Eliasziw, Munoz, and Hachinski); Department of Community Health and General Practice, University of Kuopio (Finland) (Dr Sulkava); and Memory Research Unit, Department of Neurology (Dr Erkinjuntti), and Department of Pathology (Dr Haltia), University of Helsinki (Finland).
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