VCING scoring and white matter arteriolosclerosis show relationships to dementia status and white matter damage in an unselected ageing brain cohort

Introduction Vascular disease is associated with late-life dementia and other morbidities during life and commonly coexists with neurodegenerative pathologies. A complex variety of lesions can be documented, which has made development of standardised operationalised criteria difficult. A semiquantitative approach, vascular cognitive impairment neuropathology guidelines (VCING), has been developed that provides a score based on assessment of occipital white matter arteriolosclerosis, occipital leptomeningeal cerebral amyloid angiopathy (CAA) and the presence of any macroscopic infarct.

Methods We applied VCING assessment to an ageing population-derived neuropathology cohort derived from two subcentres of the cognitive function and ageing study (n = 158, 63.7% female and 36.3% male).

Results Vascular pathology using this method was common in this UK ageing population sample with 75% of individuals having a score of 1 or more. VCING score was associated with the presence of dementia at death, even accounting for Alzheimer's disease neuropathological change (ADNC). Of the VCING components, white matter arteriolosclerosis, but not CAA or infarcts, was associated with dementia (after adjustment for ADNC). VCING score was not associated with vascular risk factors during life, but males were at greater risk of a higher VCING score than females. VCING and arteriolosclerosis were associated with white matter pallor and perivascular space widening as markers of white matter damage. Venous collagenosis was also associated with white matter pallor. There was an association between VCING score and ADNC in regression analysis, and the association was particularly strong for the CAA component.

Conclusions VCING is a straightforward method to assess vascular pathology in neuropathology cohorts and retains its association with dementia. The arteriolosclerosis component, in particular, is related to dementia and to white matter damage, whereas venous-side effects may also be important for the latter. The strong association of the CAA component with ADNC measures, however, raises the question of whether the VCING approach may have some confounding effects with ADNC.

Summary

VCING criteria provide a score to assess cerebrovascular disease based on the presence of any infarct > 10 mm, occipital leptomeningeal CAA and occipital white matter arteriolosclerosis.

We assessed VCING in a UK population-representative neuropathology cohort from the Cognitive Function and Ageing Neuropathology Study.

VCING and its arteriolosclerosis component are associated with dementia status at death and with other occipital white matter pathologies, whereas venous collagenosis may also be important white matter pathology.