Prevalence of small cerebral bleeds in patients with a neurodegenerative dementia: A neuropathological study
Introduction
Magnetic resonance imaging (MRI) has shown a high incidence of small cerebral bleeds in patients with small-vessel diseases such as cerebral amyloid angiopathy (CAA) and lipohyalinosis [1], [2], [3]. Small cerebral bleeds are also found in asymptomatic patients and in those with arterial hypertension and white matter changes [4], [5], [6]. They are frequently observed in brains of patients suffering from Alzheimer dementia (AD) and are mainly related to CAA [7], [8].
The number of small cerebral bleeds detected depends on the MRI characteristics, such as pulse sequence, sequence parameters, spatial resolution, magnetic field strength and image post-processing [9].
However, there are only a few studies dealing with the direct comparison of the histology of small cerebral bleeds with post-mortem gradient-echo MRI [3], [10], [11], [12], [13] and none were performed in the setting of neurodegenerative dementias.
This neuropathological study aims to describe the prevalence and severity of cerebrovascular lesions, including hemorrhagic ones, in patients with AD, dementia with Lewy bodies (DLB) and fronto-temporal dementia (FTD).
Section snippets
Dementia population
Between 2000 and 2008, 65 consecutive patients with a clinical history of degenerative dementia were autopsied. Ten (15%) patients had been followed-up in a general hospital and detailed clinical data were not available. Fifty-five (85%) patients had been followed-up in the Memory Clinic of the Lille University Hospital.
Controls
During the same period of time, 10 brains from controls were available. The controls consisted of brains of elderly patients without evident signs of cognitive decline, who died
Results
The median age at death was 81 (interquartile range {IQR 74–86}) in the AD, 78 (IQR 76–85) in DLB, 69 (IQR 62–78) in FTD and 69 (IQR 62–78) years in the control group. The AD and the DLB patients were significantly older than the controls (P = 0.002) while those with FTD were of similar age. Female gender represented, respectively, 48.9%, 37.5%, 50.0% and 40.0%.
Three brains with AD had also some cortical Lewy bodies, while in 5 brains with DLB Alzheimer features, stadium I up to III according to
Discussion
The present postmortem study confirms the high incidence of small bleeds in brains of AD patients but also their presence in brains of patients with DLB. Both groups of patients had a frequent history of arterial hypertension.
Several MRI studies have demonstrated the high incidence of small cerebral bleeds in patients with AD [8], [9], [21], [22], [23]. Their presence is also considered as an independent predictor of cognitive impairment in different settings [24], [25], [26].
In the present
References (38)
- et al.
Cerebral microbleeds: a guide to detection and interpretation
Lancet Neurol
(2009) Frontal lobe degeneration of non-Alzheimer Type. I Neuropathology
Arch Gerontol Geriatr
(1987)MRI of the “Alzheimer syndrome”
J Neuroradiol
(2007)- et al.
MRI detection of new hemorrhages: potential marker of progression of amyloid angiopathy
Neurology
(1999) - et al.
Frequency and location of microbleeds in patients with primary intracerebral hemmorhage
Stroke
(2000) - et al.
Histopathologic analysis of foci of signal loss on gradient-echo T2*- weighted MR images in patients with spontaneous intracerebral hemorrhage: evidence of microangiopathy-related microbleeds
Am J Neuroradiol
(1999) - et al.
MRI evidence of past cerebral microbleeds in healthy elderly population
Neurology
(1999) - et al.
Silent intracerebral microhemorrhages in patients with ischemic stroke. Amsterdam Vascular Medicine Group
Ann Neurol
(1998) - et al.
Spontaneous brain microbleeds: systematic review, subgroup analyses and standards for study design and reporting
Brain
(2007) - et al.
Cerebral amyloid angiopathy in brains of patients with Alzheimer's disease: The CERAD experience, part XV
Neurology
(1996)
Microbleeds in Alzheimer disease are more related to cerebral amyloid angiopathy than to cerebrovascular disease
Dement Geriatr Cogn Disord
Small chronic hemorrhages and ischemic lesions in association with spontaneous intracerebral hematomas
Stroke
Cerebral microbleeds in CADASIL. A gradient-echo magnetic resonance imaging and autopsy
Stroke
Postmortem MRI as a useful tool for investigation of cerebral microbleeds
Stroke
Direct comparison of histology of microbleeds with postmortem MR images: a case report
Cerebrovasc Dis
Evolution of neuronal changes in the course of Alzheimer's diease
J Neural Transm Suppl
Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop
Neurology
Diagnosis and management of dementia with Lewy bodies: third report of the DLB consortium
Neurology
Fronto-temporal degenerative dementia. A modern neuropathologic approach
Bull Acad Natl Méd
Cited by (69)
Cortical microinfarcts and the aging brain
2021, Assessments, Treatments and Modeling in Aging and Neurological Disease: The Neuroscience of AgingSafety of oral anticoagulants on experimental brain microbleeding and cognition
2019, NeuropharmacologyLobar intracerebral haematomas: Neuropathological and 7.0-tesla magnetic resonance imaging evaluation
2016, Journal of the Neurological SciencesThe incidence of post-mortem neurodegenerative and cerebrovascular pathology in mixed dementia
2016, Journal of the Neurological SciencesCitation Excerpt :A semi-quantitative rating scale was used on a standard coronal section of a cerebral hemisphere, at the level of the mammillary body, to evaluate the severity of small cerebrovascular lesions according to a previously described method. The mean values of white matter changes (WMC), CAA, lacunar infarcts, territorial infarcts, cerebral hematomas, micro-infarcts and micro-bleeds were determined and compared between the different groups [14]. Univariate comparisons of unpaired groups were performed with the Fisher's exact test for categorical data.
Exploring the Impact of Cerebral Microbleeds on Stroke Management
2023, Neurology International