Differences in Cerebral Small Vessel Disease in Patients with Dementia in Alzheimer’s Disease Compared to Patients with Dementia in Distal Cerebral Atherosclerosis

Background: The number of people with dementia is constantly increasing and currently amounts to over 55 million people worldwide. Common causes leading to its progression are Alzheimer's disease and distal cerebral atherosclerosis. These diseases are accompanied by the development of specific Cerebral Small Vessel Disease.

Aims: This research is devoted to comparing Cerebral Small Vessel Disease caused by Alzheimer's dementia to Cerebral Small Vessel Disease, developing in dementia caused by distal cerebral atherosclerosis.

Methods: For the research, 1024 dementia patients aged 28-81 (mean age 77.5) were selected, 719 males (70.22%), 305 females (29.78%).

Test Group 1. 93 (9.08%) patients had Alzheimer's disease. According to dementia severity, the patients were divided into: a preclinical stage (dementia TDR-0) - 10, a mild stage (dementia TDR-1) - 26, a moderately severe stage (dementia TDR-2) - 40, a severe stage (dementia TDR-3) - 17 people.

Test Group 2. 931 (90.92%) patients had distal cerebral atherosclerotic lesions. Of these: 52 (5.59%) had early signs of chronic cerebrovascular insufficiency, 484 (51.99%) had pronounced signs of chronic cerebrovascular insufficiency, 306 (32.87%) had severe chronic cerebrovascular insufficiency, 27 (2.90%) had Binswanger's disease, 62 (6.66%) had vascular parkinsonism. According to dementia severity, patients were divided into: 445 (47.80%) with unpronounced dementia, 332 (35.66%) with CDR-1 dementia, 132 (14.18%) with CDR-2 dementia, and 22 (2.36%) with CDR-3 dementia.

Results:

Test Group 1. In all 93 cases, dyscirculatory angiopathy of Alzheimer’s type was detected, which is manifested in atherosclerosis absence, reduction of capillaries in the temporal regions, large arteriovenous shunts development, venous trunks expansion, discharge of arterial blood into the venous bed, and venous stasis.

Test Group 2. In all 931 cases, multiple distal cerebral atherosclerotic lesions were detected, combining stenosis and occlusion, small arteriovenous shunts, absence of pathological venous trunks, venous stasis.

Conclusion: In Alzheimer's disease, Cerebral Small Vessel Disease has a specific type of changes characteristic only to this disease, which are manifested in Dyscirculatory angiopathy of Alzheimer's type.

In distal cerebral atherosclerosis, Cerebral Small Vessel Disease manifests itself in atherosclerotic lesions of the distal arteries, arterioles and capillaries. These lesions are not found in Alzheimer's disease.