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Mixed dementias are clinically under-recognised and need neuropathological confirmation. The most frequent types are those composed of Alzheimer’s dementia (AD) associated with cerebral amyloid angiopathy (CAA), cerebral arteriosclerotic micro-angiopathy (CAMA) and Lewy body disease (LBD). The present neuropathological study with 7.0-tesla magnetic resonance imaging (MRI) compares the impact and the distribution of cerebrovascular lesions between unmixed AD brains to those with different types of associated disorders. Twenty-six unmixed AD brains were compared to 12 associated with LBD, eight with CAMA and 24 with CAA. On neuropathological examination brains with AD-CAA had the most severe cerebrovascular lesions, those with AD-CAMA had a higher number of lacunes and in the AD-LBD brains only an increase of cortical micro-infarcts was observed. On MRI examination, white matter changes were only increased in the AD-CAA group. Cortical micro-infarcts were significantly more frequent in all the sections of the AD-CAA and AD-CAMA groups. In the AD-LBD brains, they were only moderately more common in the occipital section. Cortical micro-bleeds were observed in all mixed dementia cases. A moderate amount of superficial siderosis was only seen in the AD-CAA brains. The present study confirms our previous findings that CAA and CAMA are the main causes of occurrence of different cerebrovascular lesions in the mixed AD brains.

Cerebrovascular Lesions in Alzheimer-associated Diseases – A Neuropathological Study with 7.0-tesla Magnetic Resonance Imaging