Psychoses Associated with Vascular Disease
Theoretically, senility and arteriosclerotic brain disease are distinguishable, but in practice such a differentiation often becomes difficult.
In reviewing the early literature on mental symptoms of the aged, one discovers that much has been written concerning senile psychoses, but material on the psychoses of arteriosclerosis is scant.
The arteriosclerotic brain and the senile brain each have distinct pathologic patterns. Disease of the blood vessels is not constant in the aged and in itself cannot be considered the sole basis for the pathologic findings of senility.
In general, arteriosclerotic brain disease occurs in people over 50 years of age. The fact that there is a familial variation of this disorder has been well established. Certain factors such as worry, alcoholism, extreme mental exertion, and diet are considered to be contributory. The condition of the “arterial tree” is often an excellent index of one’s age, and the adage that “a man is as old as his arteries” holds much truth.
Cobb classifies the pathologic changes of cerebral arteriosclerosis as follows:1
Large vessel sclerosis. This type involves primarily the arteries of the base of the brain as well as the larger vessels of the cerebrum, cerebellum, brain stem, and choroid plexus. The process is rare in the vessels of the cortex, and from the histologic standpoint resembles arteriosclerosis as seen throughout the entire vascular system.
Arteriolarsclerosis. Arteriolarsclerosis is characterized by a hyaline degeneration of the intima in the arterioles and capillaries. It is a diffuse hyperplastic process involving primarily the vessels. . .