Differences between vascular and microcirculatory disorders of the brain in patients with dementia suffering from Alzheimer's disease and Binswanger's disease.

Abstract

During differential diagnosis of various types of dementia, there are certain difficulties in determining disorders of cerebral angioarchitectonics and microcirculation. We present the features of cerebrovascular and microcirculatory disorders in Alzheimer's disease (AD) and Binswanger's disease (BD). The research included 120 patients, of whom: (1) 93 aged 34-80 (average age 67.5), 32 (34.40%) men and 61 (65.59%) women, suffering from AD. According to dementia severity, the patients were subdivided: (TDR-0) - 10, (TDR-1) - 29, (TDR-2) - 36, (TDR-3) - 18 people; (2) 27 aged 58-81 (average age 78), 17 (62.96%) men and 10 (27.04%) women, suffering from BD. The patients were subdivided according to dementia severity: (CDR-1) - 17, (CDR-2) - 10 people. The examination plan included cerebral MRI, CT, scitrigraphy (SG), rheoencephalography (REG), cerebral multi-gated angiography (MUGA). Patients with AD show the following changes in angioarchitectonics and microcirculation: (1) No calcium salts deposits in intracerebral vessels; (2) Increased tortuosity of distal intracranial arteries; (3) Capillary bed reduction in the temporal and fronto-parietal regions; (4) Development of multiple arteriovenous shunts in the same regions; (5) Development of abnormal venous trunks with early venous discharge of arterial blood in the same regions; (6) Development of intracerebral stasis of venous blood. These vascular changes are called dyscirculatory angiopathy of Alzheimer's type (DAAT). Patients with BD show the following changes in angioarchitectonics and microcirculation: (1) Multiple calcium salts deposition in intracerebral vessels; (2) Disseminated reduction of the capillary bed in the subcortical regions; (3) Development of multiple disseminated arteriovenous shunts in the subcortical regions; (4) No pronounced intracerebral venous stasis. Dyscirculatory angiopathy of Alzhemer's type, regardless of dementia severity, is a cerebrovascular and microcirculatory brain lesion specific for AD and not associated with atherosclerotic process. BD patients, irrespective of dementia severity, have vascular disorders of atherosclerotic nature. Anatomically, capillary bed reduction and arteriovenous shunts are located exclusively in the white matter of the brain. Due to the disseminated development of arteriovenous shunts, pronounced venous stasis does not occur. Timely identification of these changes is of an important diagnostic nature.