Inverse Relationship Between Cerebrovascular Lesions and Severity of Lewy Body Pathology in Patients With Lewy Body Diseases

Abstract

Cerebrovascular pathology is a major cause of stroke and mortality. Studies on prevalence of cerebrovascular pathologies in dementia with Lewy bodies (DLBs) and Parkinson disease (PD) patients are scarce and contradictory. We aimed to determine the prevalence and severity of cerebrovascular pathologies in DLB and PD and to analyze their relationship to LB pathology. The prevalence and severity of atherosclerosis in the circle of Willis, cerebral amyloid angiopathy, cerebral infarcts, hemorrhages, small-vessel disease, white matter lesions, including the Consortium to Establish a Registry for Alzheimer Disease (CERAD) protocol as well as Braak neurofibrillary tangle stages for AD pathology were analyzed in autopsy-verified DLB (n = 13), PD (n = 102), and control subjects (n = 53). In all patient groups, the extent of LB pathology was inversely correlated to the severity of most vascular pathologies (atherosclerosis, infarcts, and small-vessel disease; all p < 0.05). By contrast, cerebral amyloid angiopathy, CERAD, and Braak neurofibrillary tangle stages were positively correlated with LB pathology (p < 0.05). Whereas the overall prevalence and severity of small-vessel disease, infarcts, hemorrhages, and white matter lesions were comparable among both disease groups, the extents of atherosclerosis, cerebral amyloid angiopathy, CERAD, and Braak neurofibrillary tangle stages were significantly higher in DLB than in those of PD patients (p < 0.05). Microinfarcts were statistically more prevalent in each patient group than in controls, whereas gross infarcts predominated in controls (p < 0.05 each). In conclusion, DLB and PD patients with advanced LB pathology were less likely to show severe cerebrovascular disease or history of stroke.

Prevalence and Pathology of Dementia with Lewy Bodies in the Oldest Old: A Comparison with Other Dementing Disorders

“…In a recent autopsy study of DLB and PD cases, the extent of Lewy pathology was inversely correlated with the severity of most vascular pathologies (atherosclerosis, infarcts and small vessel disease; all p < 0.05). By contrast, CAA, CERAD and Braak AD stages were positively correlated with Lewy pathology (p < 0.05) [75]. Similar to our findings, the extent of CAA and Braak AD stages was higher in DLB than in PD patients.…”

Cerebral Microinfarcts: A Systematic Review of Neuropathological Studies

“…The most commonly used neuropathological criteria for AD were the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) (Mirra et al, 1991) and the Braak criteria (Braak and Braak, 1991). Fifteen studies (41%) primarily classified the patients on clinical criteria (Erkinjuntti et al, 1988;Vinters et al, 2000;Xuereb et al, 2000;White et al, 2002;Gold et al, 2007;Sonnen et al, 2007;Schneider et al, 2007a, b;Strozyk et al, 2010;Troncoso et al, 2008;White, 2009;Wang et al, 2009;Brayne et al, 2009;Ghebremedhin et al, 2010;Sinka et al, 2010;Arvanitakis et al, 2011). The Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) was used most frequently, followed by the Cognitive Assessment Screening Instrument (Teng et al, 1994).…”

Orthostatic hypotension in dementia with Lewy bodies

“…В 40% случаев ДТЛ нейро-дегенерация сопровождается сосудистыми измене-ниями вещества головного мозга. При ДТЛ большее распределение телец Леви отражает менее выражен-ное цереброваскулярное поражение [47], однако влияние сосудистых изменений на течение ДТЛ тре-бует изучения.…”