On the regional distribution of cerebral microvascular 'raspberries' and their association with cerebral atherosclerosis and acute circulatory failure

Increased frontocortical microvascular raspberry density in frontotemporal lobar degeneration compared to Lewy body disease and control cases: a neuropathological study

Background: Brain raspberries are histologically defined microvascular entities that are highly prevalent in the neocortex. Increased cortical raspberry density occurs in vascular dementia, but also with advancing age. Here, we examined the raspberry density in two neurodegenerative diseases, wherein vascular alterations distinct from conventional vascular risk factors have been indicated: frontotemporal lobar degeneration (FTLD) and Lewy body disease (LBD). Methods: This retrospective study included 283 clinically autopsied individuals: 105 control cases without neurodegenerative disease, 98 FTLD cases (mainly FTLD-tau and FTLD-TDP), and 80 LBD cases (mainly neocortical). The raspberry density was quantified on haematoxylin-eosin-stained tissue sections from the frontal cortex, and the frontocortical atrophy was ranked 0-3. Results: There was a higher raspberry density in the FTLD group compared to both other groups (P ≤ 0.001; Games-Howell post hoc test). The difference between the FTLD and LBD groups remained significant in multiple linear regression models that included age, sex, and either brain weight (P = 0.034) or cortical atrophy (P = 0.012). The difference between the FTLD and control groups remained significant when including age, sex, and brain weight in the model (P = 0.004), while a trend towards significance was demonstrated when including age, sex, and cortical atrophy (P = 0.054). Further analyses of the FTLD group revealed a trend towards a positive correlation between raspberry density and cortical atrophy (P = 0.062; Spearman rank correlation). Comparisons of FTLD subgroups were inconclusive. Conclusion: The frontocortical raspberry density is increased in FTLD. An examination of the raspberry density in relation to a quantitative measure of cortical atrophy is motivated to validate the results. Future studies are needed to determine whether increased raspberry density in FTLD could function as a marker for more widespread vascular alterations, and to elucidate the relation between microvascular alterations and neurodegenerative disease.

Cortical microvascular raspberries and ageing: an independent but not exclusive relationship

INTRODUCTION

Raspberries are cerebral microvascular formations of unknown origin, defined as three or more transversally sectioned vascular lumina surrounded by a common perivascular space. We have previously demonstrated an increased raspberry density in the cortex of patients with vascular dementia and cerebral atherosclerosis, while studies by other authors on overlapping and synonymously defined vascular entities mainly associate them with advancing age. The aim of the present study was to examine the relationship between raspberries and age in a large study sample while including multiple potential confounding factors in the analysis.

MATERIALS AND METHODS

Our study sample consisted of 263 individuals aged 20-97 years who had undergone a clinical autopsy including a neuropathological examination. The cortical raspberry density had either been quantified as part of a previous study or was examined de novo in a uniform manner on haematoxylin- and eosin-stained tissue sections from the frontal lobe. The medical records and autopsy reports were assessed regarding neurodegeneration, cerebral infarcts, cerebral atherosclerosis and small vessel disease, cardiac hypertrophy, nephrosclerosis, hypertension, and diabetes mellitus. With the patients grouped according to 10-year age interval, non-parametric tests (the Kruskal-Wallis test, followed by pairwise testing with Bonferroni-corrected P values) and multiple linear regression models (not corrected for multiple tests) were performed.

RESULTS

The average raspberry density increased with advancing age. The non-parametric tests demonstrated statistically significant differences in raspberry density when comparing the groups aged 60-99 years and 70-99 years to those aged 20-29 years (P < 0.012) and 30-59 years (P < 0.011), respectively. The multiple linear regression models demonstrated positive associations with age interval (P < 0.001), cerebral atherosclerosis (P = 0.024), cardiac hypertrophy (P = 0.021), hypertension subgrouped for organ damage (P = 0.006), and female sex (P = 0.004), and a tendency towards a negative association with Alzheimer's disease neuropathologic change (P = 0.048).

CONCLUSION

The raspberry density of the frontal cortex increases with advancing age, but our results also indicate associations with acquired pathologies. Awareness of the biological and pathological context where raspberries occur can guide further research on their origin.

A neuropathologic feature of brain aging: multi-lumen vascular profiles

Cerebrovascular pathologies other than frank infarctions are commonly seen in aged brains. Here, we focus on multi-lumen vascular profiles (MVPs), which are characterized by multiple vessel lumens enclosed in a single vascular channel. Little information exists on the prevalence, risk factors, and co-pathologies of MVPs. Therefore, we used samples and data from the University of Kentucky Alzheimer's Disease Research Center (n = 91), the University of Kentucky Pathology Department (n = 31), and the University of Pittsburgh Pathology Department (n = 4) to study MVPs. Age at death was correlated with MVP density in the frontal neocortex, Brodmann Area 9 (r = 0.51; p < 0.0001). Exploratory analyses were performed to evaluate the association between conventional vascular risk factors (e.g., hypertension, diabetes), cardiovascular diseases (e.g., heart attack, arrhythmia), and cerebrovascular disease (e.g., stroke); the only nominal association with MVP density was a self-reported history of brain trauma (Prevalence Ratio = 2.1; 95 CI 1.1-3.9, before correcting for multiple comparisons). No specific associations were detected between neuropathological (e.g., brain arteriolosclerosis) or genetic (e.g., APOE) variables and MVP density. Using a tissue clearing method called SeeDB, we provide 3-dimensional images of MVPs in brain tissue. We conclude that MVPs are an age-related brain pathology and more work is required to identify their clinical-pathological correlation and associated risk factors.