Haglund Mattias, Passant Ulla, Sjöbeck Martin, Ghebremedhin Estifanos, Englund Elisabet
Division of Neuropathology, Department of Pathology and Cytology, Lund University Hospital, Sweden.
Int J Geriatr Psychiatry. 2006 Jul;21(7):681-7. doi: 10.1002/gps.1550.
Vascular dementia (VaD) has occasionally been associated with cerebral amyloid angiopathy (CAA), but the prevalence and significance of this counterintuitive relationship are poorly known. Therefore, we investigated the presence and characteristics of CAA in brains of VaD cases.
We examined temporal and parietal regions of the cerebral cortex of 26 consecutive VaD cases from the Lund Longitudinal Dementia Study. We carried out immunohistochemistry and routine stainings, determined Apolipoprotein E (ApoE) genotypes, and obtained clinical characteristics on the studied group for retrospective analysis.
CAA was marked in eight out of 26 cases, and correlated strongly with the presence of cortical microinfarcts, both in the temporal lobe and in the parietal lobe. Based on comparisons with eight age-matched VaD cases without CAA, the clinical records suggested that VaD cases with CAA as a group exhibited less pronounced neurological symptoms. A clear contribution of the ApoE genotype could not be identified.
Based on a combination of the clinical and pathological data, we suggest that microinfarcts in the cerebral cortex associated with severe CAA may be the primary pathological substrate in a significant proportion of VaD cases. Future studies should be undertaken to confirm or dismiss the hypothesis that these cases exhibit a different symptom profile than VaD cases without CAA.
血管性痴呆（VaD）偶尔与脑淀粉样血管病（CAA）相关，但这种看似矛盾的关系的患病率及意义鲜为人知。因此，我们调查了VaD病例脑内CAA的存在情况及特征。
我们检查了来自隆德纵向痴呆研究的26例连续VaD病例大脑皮质的颞叶和顶叶区域。我们进行了免疫组织化学和常规染色，确定了载脂蛋白E（ApoE）基因型，并获取了研究组的临床特征以进行回顾性分析。
26例病例中有8例CAA明显，且在颞叶和顶叶均与皮质微梗死的存在密切相关。与8例年龄匹配的无CAA的VaD病例相比，临床记录表明，伴有CAA的VaD病例组神经症状不那么明显。未发现ApoE基因型有明确作用。
基于临床和病理数据，我们认为，与严重CAA相关的大脑皮质微梗死可能是相当一部分VaD病例的主要病理基础。未来应开展研究以证实或否定这些病例与无CAA的VaD病例表现出不同症状特征这一假说。
