Alzheimer’s disease (AD) is the most common dementia in older individuals followed by vascular dementia (VaD). Differential diagnosis is complicated by the frequent occurrence of mixed dementia (MD), the coexistence of both VaD and AD. Clinicopathological correlations have demonstrated the influence of macroscopic vascular lesions on the clinical expression of Alzheimer’s disease (AD) thus providing support for the inclusion of these lesions in establishing the neuropathological diagnosis of MD. However, the clinical significance of isolated microvascular cortical lesions remains obscure. To address this issue, we developed microvascular scores based on semi-quantitative assessments of demyelination, cortical and white matter gliosis, and microvascular infarcts in the anterior hippocampus, inferior temporal cortex, frontal cortex and parietal cortex bilaterally. We applied these scores to 47 consecutive autopsied dementia cases with Braak stages of II or less. Total microinfarct and demyelination scores explained 19% and 13% respectively of the variability in cognitive function as measured by the clinical dementia rating scale (CDR). Gliosis scores did not predict CDR stage. These results suggest that neuropathological criteria for MD should include semi-quantitative assessments of microscopic ischemic pathology which should take into account demyelination and cortical microinfarcts.
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