Cerebrovascular Changes in Dementia Patients with Alzheimer’s Disease and Vascular Parkinsonism

Abstract

AbstractBackgroundWhen examining patients with dementia, it is necessary to clearly differentiate the developed cerebrovascular and microcirculatory changes. We present the features of cerebral angioarchitectonics and microcirculation in Alzheimer’s disease (AD) and vascular parkinsonism (VP).MethodsThe research included 155 patients. The examination included assessment of CDR, TDR, MMSE, cerebral MRI, CT, scintigraphy (SG), rheoencephalography (REG), cerebral multi‐gated angiography (MUGA).Patients were divided into:• 93 people aged 34‐80 (mean age 67.5): men ‐ 32 (34.40%), women ‐ 61 (65.59%), suffering from AD. According to dementia severity, patients were subdivided: (TDR‐0) ‐ 10, (TDR‐1) ‐ 29, (TDR‐2) ‐ 36, (TDR‐3) ‐ 18 people;• 62 people aged 52‐80 (mean age 77): men ‐ 48 (77.42%), women ‐ 14 (22.58%), suffering from VP. According to dementia severity, patients were subdivided: no dementia ‐ 30 people, dementia at level (CDR‐1) ‐ 32 people.ResultsIn AD patients, changes in angioarchitectonics and microcirculation are manifested in:• Absence of calcium salts deposits and atherosclerotic changes in intracerebral vessels;• Increased tortuosity of distal intracranial arteries;• Reduction of the capillary bed in the temporal and frontoparietal regions;• Development of multiple, large arteriovenous shunts with early venous discharge of arterial blood in the same regions;• Development of abnormal, intracerebral venous trunks;• Development of intracerebral stagnation of venous blood.These changes are called “Discirculatory angiopathy of Alzheimer’s type” (DAAT).In patients with VP, changes in angioarchitectonics and microcirculation are manifested in:• Multiple calcium salts deposits with atherosclerotic changes in intracranial vessels, mainly in the thalamus, basal ganglia, and pons;• Local decrease in subcortical cerebral capillary blood flow in the same regions;• Development of local subcortical small intracerebral arteriovenous shunts;• Absence of expressed intracerebral venous blood stagnation.ConclusionsDiscirculatory angiopathy of Alzheimer’s type (DAAT), regardless of dementia severity, is an AD‐specific cerebrovascular and microcirculatory lesion of the brain, unconnected with atherosclerotic process.In patients with VP, regardless of dementia, vascular and microcirculatory changes are atherosclerotic in nature. Capillary bed lesions, presence of arteriovenous shunts are subcortical in nature, mainly in the region of the thalamus, basal ganglia, and bridge. Marked venous stasis does not occur in this case.