The need to unify neuropathological assessments of vascular alterations in the ageing brain: Multicentre survey by the BrainNet Europe consortium

Irina Alafuzoff, Ellen Gelpi, Safa Al-Sarraj, Thomas Arzberger, Johannes Attems, Istvan Bodi, Nenad Bogdanovic, Herbert Budka, Orso Bugiani, Elisabet Englund, Isidro Ferrer, Stephen Gentleman, Giorgio Giaccone, Manuel B Graeber, Tibor Hortobagyi, Romana Höftberger, James W Ironside, Kurt Jellinger, Nikolaos Kavantzas, Andrew KingPenelope Korkolopoulou, Gábor G Kovács, David Meyronet, Camelia Monoranu, Piero Parchi, Efstratios Patsouris, Wolfgang Roggendorf, Annemieke Rozemuller, Danielle Seilhean, Nathalie Streichenberger, Dietmar R Thal, Stephen B Wharton, Hans Kretzschmar

Research output: Contribution to journalArticlepeer-review


Here, we summarise the results after carrying out a large survey regarding the assessment of vascular alterations, both vessel changes and vascular lesions in an inter-laboratory setting. In total, 32 neuropathologists from 22 centres, most being members of BrainNet Europe (BNE), participated by filling out a questionnaire with emphasis on assessment of common vascular alterations seen in the brains of aged subjects. A certain level of harmonisation has been reached among BNE members regarding sectioning of the brain, harvesting of brain tissue for histology and staining used when compared to the survey carried out in 2006 by Pantoni and colleagues. The most significant variability was seen regarding the assessment of severity and of clinical significance of vascular alterations. Two strategies have recently been recommended regarding the assessment of vascular alterations in aged and demented subjects. The National Institute on Aging - Alzheimer's Association (NIA-AA) recommends the assessment of hippocampal sclerosis, vascular brain injury and microvascular lesions in 12 regions. Although this strategy will be easy to follow, the recommendations do not inform how the load of observed alterations should be assessed and when the observed lesions are of significance. Deramecourt and his colleagues recommend an assessment and semiquantitative grading of various pathologies in 4 brain regions. This strategy yielded a total score of 0 to 20 as an estimate of pathology load. It is, however, not clear which score is considered to be of clinical significance. Furthermore, in several BNE trials the semiquantitative assessment has yielded poor agreement rates; an observation that might negatively influence the strategy proposed by Deramecourt and his colleagues. In line with NIA-AA, a dichotomised approach of easily recognisable lesions in a standardised set of brain regions harvested for neuropathological assessment and applying reproducible sampling and staining strategies is recommended by BNE. However, a simple strategy regarding assessment of load of alteration is urgently needed to yield reproducible, and at the same time, comparable results between centres.
Original languageEnglish
Pages (from-to)825-833
Number of pages9
JournalExperimental gerontology
Issue number11
Publication statusPublished - Nov 2012


  • Severity of Illness Index
  • Questionnaires
  • Reproducibility of Results
  • Humans
  • Aging
  • Specimen Handling
  • Brain
  • Cerebrovascular Circulation
  • Dementia
  • Staining and Labeling
  • Cerebrovascular Disorders


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