Review: Cerebral microvascular pathology in ageing and neurodegeneration

Brown, W. R.; Thore, C. R.

doi:10.1111/j.1365-2990.2010.01139.x

Cited by 749Neurological Disease Mechanisms and TreatmentsCerebrovascular and genetic disordersBarrier Structure and Function Studies

Review: Cerebral microvascular pathology in ageing and neurodegeneration

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Brown, W. R., Thore, C. R.·2011·Neuropathology and Applied Neurobiology

DOI 10.1111/j.1365-2990.2010.01139.xPMC PMC3020267

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Abstract

This review of age-related brain microvascular pathologies focuses on topics studied by this laboratory, including anatomy of the blood supply, tortuous vessels, venous collagenosis, capillary remnants, vascular density and microembolic brain injury. Our studies feature thick sections, large blocks embedded in celloidin, and vascular staining by alkaline phosphatase. This permits study of the vascular network in three dimensions, and the differentiation of afferent from efferent vessels. Current evidence suggests that there is decreased vascular density in ageing, Alzheimer's disease and leukoaraiosis, and cerebrovascular dysfunction precedes and accompanies cognitive dysfunction and neurodegeneration. A decline in cerebrovascular angiogenesis may inhibit recovery from hypoxia-induced capillary loss. Cerebral blood flow is inhibited by tortuous arterioles and deposition of excessive collagen in veins and venules. Misery perfusion due to capillary loss appears to occur before cell loss in leukoaraiosis, and cerebral blood flow is also reduced in the normal-appearing white matter. Hypoperfusion occurs early in Alzheimer's disease, inducing white matter lesions and correlating with dementia. In vascular dementia, cholinergic reductions are correlated with cognitive impairment, and cholinesterase inhibitors have some benefit. Most lipid microemboli from cardiac surgery pass through the brain in a few days, but some remain for weeks. They can cause what appears to be a type of vascular dementia years after surgery. Donepezil has shown some benefit. Emboli, such as clots, cholesterol crystals and microspheres can be extruded through the walls of cerebral vessels, but there is no evidence yet that lipid emboli undergo such extravasation.

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Deep white matter is supplied by long penetrating arterioles at border zones between vascular territories and is more vulnerable to reduced blood flow.
“regions of the deep white matter are supplied by long penetrating arterioles arising from the pial cortical network at the border between non-overlapping vascular territories of the anterior and middle cerebral arteries, and as such are more vulnerable to reductions in blood flow (Brown and Thore, 2011; De Reuck, 1971)”
From The Pathobiology of Vascular Dementia (2013) · cites this paper as Brown and Thore, 2011
Deep white matter tracts are especially vulnerable to vascular insufficiency because they lie at distal borders between vascular territories and their vasculature is susceptible to risk factors.
“Owing to their location at the distal border between different vascular territories (De Reuck, 1971) (fig 4) and to the susceptibility of their vasculature to risk factors (Brown and Thore, 2011), deep white matter tracts are particularly vulnerable to vascular insufficiency.”
From The Pathobiology of Vascular Dementia (2013) · cites this paper as Brown and Thore, 2011
Damage to neurons and glia is associated with endothelial cell atrophy and microvascular rarefaction due to loss of trophic support.
“Owing to their trophic support of vascular cells, dysfunction and damage to neurons and glia is associated with endothelial cell atrophy and microvascular rarefaction (Brown and Thore, 2011).”
From The Pathobiology of Vascular Dementia (2013) · cites this paper as Brown and Thore, 2011

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Authors: Brown, W. R., & Thore, C. R.
Affiliations: Atrium Health Wake Forest Baptist (US)
Corresponding author: Brown, W. R.
ORCID: Brown, W. R.
Venue: Neuropathology and Applied Neurobiology
Publisher: Wiley
Published: 2011-01-11
Volume: 37
Issue: 1
Pages: 56-74
ISSN: 0305-1846 (ISSN-L)
1365-2990
DOI: 10.1111/j.1365-2990.2010.01139.x
PMC: PMC3020267
OpenAlex: W1567524252
Cited by: 749
References: 193
Citations by year: 2026: 23 · 2025: 44 · 2024: 37 · 2023: 58 · 2022: 63 · 2021: 57 · 2020: 59 · 2019: 63 · 2018: 49 · 2017: 59 · 2016: 41 · 2015: 48 · 2014: 58 · 2013: 33 · 2012: 38
FWCI: 2.39
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Neuropathology and Applied Neurobiology (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health
National Cancer Institute (CA113321, R01CA113321)
National Institute of Neurological Disorders and Stroke (NS20618, NS 36780, R01NS036780, R56NS020618, R01NS020618)
Topics: Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
Health Sciences › Medicine › Neurology › Cerebrovascular and genetic disorders
Life Sciences › Neuroscience › Neurology › Barrier Structure and Function Studies
Keywords: cerebral microvasculature, brain aging, neurodegeneration, Alzheimer's disease, white matter hyperintensities, vessel density, capillary loss, microemboli, cerebral blood flow, cerebrovascular dysfunction, hypoperfusion, vascular dementia, cholinergic dysfunction, cholinesterase inhibitors, donepezil, normal-appearing white matter, hypoxia
MeSH terms: Aging, Alzheimer Disease, Animals, Hypoxia, Arterioles, Basement Membrane, Brain, Capillaries, Cerebral Veins, Cerebrovascular Circulation, Cognition Disorders, Collagen, Humans, Hypertension, Nerve Degeneration, Parasympathetic Nervous System, Dementia, Vascular, Cholinergic Agents, Intracranial Embolism, Leukoaraiosis

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