Cerebral disease of small vessels: morphological, neuropsychological and neurovisualization comparisons

Abstract

The term "cerebrovascular disease of small vessals" (CDSV) includes neuropathological, clinical and neuroimaging manifestations lesions of small perforating arteries, arterioles, capillaries, venules and small veins. CDSV, according to the pathogenetic classification of L. Pantoni, is divided into 6 types: sporadic non-amyloid microangiopathy (SNAMA); sporadic and hereditary cerebral amyloid angiopathy (CAA); hereditary CDSV (CADASIL, CARASIL, MELAS, Fabry disease, CDSV in mutations of COL4A1 gene and others); CDSV, mediated by inflammation and immune processes; venous collagenosis; other options. In 4 chapters of the review the following are considered: morphological and neuroimaging characteristics of CDSV; cognitive impairment and CDSV: morphological, neuropsychological and neuroimaging comparisons; natural aging of the brain: morphological, neuroimaging and neuropsychological comparisons; the influence of modified risk factors (hypertension, type 2 diabetes mellitus, radiation exposure) on the course of CDSV. Conclusions. Despite the threatening consequences of CDSV, its early clinical and instrumental diagnosis has not attracted proper attention of researchers. The subject of the vast majority of studies were: CDSV of moderate and severe degree, post-stroke conditions; neuroimaging criteria for the prognosis of acute cerebrovascular disease, Alzheimer's disease and dementia in the elderly and senile persons; age differences of CDSV and cognitive impairments (CI) in terms of the overall disease duration, and not in terms of the peculiarities of its manifestation in middle or avanced age. There are objective prerequisites for establishing a methodological framework for early diagnosis of CDSV that takes into account the age of patients and the presence of modifiable risk factors. These include: the existence of consensus on the definition, classification and neuroimaging features of CDSV; availability of effective cognitive scales, which are designed to screen and determine the domain affiliation of non-dementia CD; introduction of new neuroimaging technologies that allow molecular (diffusion) research and obtain images with submillimeter resolution. Two clinical observations serve as convincing evidence of the conclusions reached on the basis of the analysis of the scientific literature.