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Cognitive Impairment and Cellular/Vascular Changes in the Cerebral White Matter a
Author(s) -
PANTONI LEONARDO,
GARCIA JULIO H.
Publication year - 1997
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/j.1749-6632.1997.tb48463.x
Subject(s) - white matter , cadasil , cerebral amyloid angiopathy , medicine , pathology , hyperintensity , dementia , neuroscience , neuroimaging , ischemia , vascular dementia , leukoencephalopathy , cardiology , magnetic resonance imaging , psychology , radiology , disease
A possible relation between cerebral white‐matter injury and dementia was intuitively attributed by Alzheimer to changes affecting the small penetrating vessels that supply the cerebral white matter. Several observations support the view that white‐matter changes detectable by neuroimaging may contribute to cognitive deficits in the elderly. But many questions concerning this matter remain partially answered. In this communication we review: (1) Selected anatomic features of the blood vessels supplying the white matter; (2) possible pathogenetic mechanisms responsible for the white‐matter changes; (3) observations on humans and animals suggesting a causal relationship between ischemia/hypoxemia and white‐matter injury; (4) epidemiologic studies linking white‐matter abnormalities with cognitive disorders. We conclude that abnormalities in the small vessels caused by aging and arterial hypertension, or other processes (cerebral amyloid angiopathy, CADASIL) together with systemic circulatory disturbances, such as abrupt variations in blood pressure values or cardiac diseases, may be the substrate of selective white‐matter injury. The damage is structurally characterized by incomplete infarction or selective cellular injury.