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(Stroke. 2006;37:1005.)
© 2006 American Heart Association, Inc.

Original Contributions

Postmortem Examination of Vascular Lesions in Cognitive Impairment

A Survey Among Neuropathological Services

Leonardo Pantoni, MD, PhD; Cristina Sarti, MD, PhD; Irina Alafuzoff, MD, PhD; Kurt Jellinger, MD; David G. Munoz, MD, FRCPC; Jun Ogata, MD Vanessa Palumbo, MD

From the Department of Neurological and Psychiatric Sciences (L.P., C.S., V.P.), University of Florence, Italy; Department of Neuroscience and Neurology (I.A.), Kuopio University, Department of Pathology, Kuopio University Hospital, Finland; Institute of Clinical Neurobiology (K.J.), Vienna, Austria; St. Michael’s Hospital (D.G.M.), University of Toronto, Canada; and Department of Pathology (J.O.), National Cardiovascular Center, Osaka, Japan.

Correspondence to Leonardo Pantoni, MD, PhD, Department of Neurological and Psychiatric Sciences, University of Florence, Viale Morgagni 85, 50134 Florence, Italy. E-mail pantoni{at}neuro.unifi.it

Background and Purpose— A full appreciation of the presence of cerebral vascular lesions in cognitively impaired patients can be ultimately reached at the neuropathological level. However, there are no detailed guidelines regarding what neuropathologists should look for at autopsy in cases of suspected vascular dementia or vascular cognitive impairment. We aimed at surveying the postmortem neuropathological procedures used in different centers in examining brain lesions of presumable or possible vascular origin in cognitively impaired patients.

Methods— Thirteen laboratories participated in the survey by filling in a semistructured questionnaire. We reviewed sampling and histology procedures in use and the neuropathological definitions of some of these lesions. Neuropathological criteria for the definition of a vascular origin of the dementing process were also surveyed.

Results— A large variability across centers was observed in the procedures used for the neuropathological examination and the histology techniques. Heterogeneity existed also in the definition of commonly found lesions (eg, white matter alterations, small vessel disease), interpretation of whether or not the lesions were reputed to be of vascular origin, and consequently in the interpretation of the cause of cognitive decline.

Conclusions— The appreciation of the presence of neuropathologically verified vascular lesions in cognitively impaired cases may be heavily influenced by the laboratory tools used and also by the heterogeneity of the criteria applied in different centers. Harmonization of neuropathological procedures is badly needed in the field of vascular dementia and vascular cognitive impairment to better understand the association between various vascular lesions and clinical symptoms such as cognitive impairment.

Key Words: dementia • dementia, vascular • diagnosis • pathology

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