Pathologic basis of vascular cognitive impairment

Parenchymal lesions of vascular etiology*

Large vessel or atherothromboembolic disease
1. Multiple infarcts
2. Single strategically placed infarct

Small vessel disease
1. Multiple lacunar infarcts in white matter and deep gray matter nuclei
2. Ischemic white matter change
3. Dilatation of perivascular spaces
4. Cortical microinfarcts and microhemorrhages

Hemorrhage
1. Intracerebral hemorrhage
2. Multiple cortical and subcortical microbleeds
3. Subarachnoid hemorrhage

Hypoperfusion
1. Hippocampal sclerosis
2. Laminar cortical sclerosis

Types of vascular lesions

Atherosclerosis
Cardiac, atherosclerotic, and systemic emboli
Arteriolosclerosis
Lipohyalinosis
Amyloid angiopathy
Vasculitis – infectious and noninfectious
Venous collagenosis
Arteriovenous fistulae – dural or parenchymal
Hereditary angiopathies – CADASIL, CARASIL, etc
Giant cell arteritis
Berry aneurysms
Miscellaneous vasculopathies – fibromuscular dysplasia, Moya-Moya
Systemic microangiopathies without vascular inflammatory cell infiltrates
Cerebral venous thrombosis

CADASIL: cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy; CARASIL: cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy.
* Microinfarcts may be localized in cortical and subcortical structures because of different etiologies.

From: Sachdev P, Kalaria R, O'Brien J, et al. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord 2014; 28:206. DOI: 10.1097/WAD.0000000000000034. Copyright © 2014. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.

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Pathologic basis of vascular cognitive impairment