Vascular pathology in Alzheimer's disease

Authors


  • This article is mainly based on the author's keynote lecture titled ‘Vascular pathology in Alzheimer’s disease' at the 3rd World Congress on Vascular Factors in Alzheimer's Disease on 7–10 April 2002 in Kyoto, Japan, as well as on several presentations at other international conferences, including ‘Amyloid senile plaque and microvessels in the brain with Alzheimer’s disease', International Symposium on Dementia, Geneva, Switzerland, 1988; ‘Electron microscopy of amyloid fibrils and microvessels’, 1st Congress on Cardiovascular Pathology in Alzheimer's Disease, New York, USA, 1996; ‘Senile plaque formation in the brain with Alzheimer’s disease', International Psychiatric Symposium, Geneva, Switzerland, 1979; ‘The relationship between amyloid fibrils around cerebral blood vessels and senile plaques’, International Symposium on Dementia and Amyloid, Tokyo, Japan, 1985; ‘The role of blood vessels for producing pathological changes in the brain with Alzheimer’s disease', Vascular Factors in Alzheimer's Disease, Newcastle, UK, 1998; ‘Ultrastructural study of senile plaques and microvessels in the brain in Alzheimer’s disease', International Conference on Dementia, Angers, France, 1987; ‘Ultrastructural study of senile plaques and microvessels in the brain with Alzheimer’s disease and Down's syndrome', International Symposium on Dementia, Helsinki, Finland, 1988; ‘Ultrastructure of amyloid fibrils in the brain with Alzheimer’s disease and Down's syndrome', International Symposium on Alzheimer's disease, Tokyo, Japan, 1987; ‘Ultrastructure of neurofibrillary tangles in the brain with Alzheimer’s disease', International Symposium on Dementia, Niigata, Japan, 1989; ‘Ultrastructure of neurofibrillary tangles in the brain with Alzheimer’s disease', 11th International Congress of Neuropathology, Symposium on Aging and Dementia, Kyoto, Japan, 1980.

Dr Taihei Miyakawa MD PhD, Amakusa Hospital, 5789 Saitsu, Hondo, Kumamoto 863-2171, Japan. Email: peter@ed.sojo-u.ac.jp

Abstract

Histopathologically, numerous senile plaques and neurofibrillary tangles were remarkably observed in the brain with Alzheimer's disease. At the same time, so much simple atrophy of nerve cells was evident under light microscopy. Electron microscopical observations of serial sections revealed that small blood vessels, including capillaries, had a deep relationship to the amyloid fibrils which formed the senile plaques and they had fallen into degenerative states. The vascular feet of the astroglial cells surrounding small blood vessels showed degenerative features, and many nerve cells in this area either showed various degrees of degeneration or apparently were destroyed. The atrophy of the brain with Alzheimer's disease is considered to be caused by the amyloid angiopathy of small blood vessels and the degeneration of capillaries and vascular feet. These findings strongly suggest that the major causal mechanism of Alzheimer's disease is an alteration of the blood–brain barrier. Morphology is an expression of both the structure and the function of organs in the living body. Based on this viewpoint, this review article emphasizes that the morphological changes to small blood vessels in the brain with Alzheimer's disease convey crucial information and clues for solving the underlying mechanism that causes the disease.

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