Gabriel Gold, MD, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland, describes the importance of identifying cortical microinfarcts. Cortical microinfarcts are cerebral vascular lesions that represent a very powerful correlate of cognitive function: in studies of pure vascular pathology, they represent over 36% of the cognitive variability. As these lesions are less than 500 microns in size and so not usually visible on neuroimaging, it is difficult to identify which patients have them. A solution could be analyzing clinical characteristics and encapsulating them in vascular scores. Indeed, analysis of 150 autopsies displayed that the CHA2DS2-VASc score was related to the presence of cortical microinfarcts: a vascular score greater than 5 means a doubled risk of cortical microinfarcts. Overall, vascular scores do have some predictive power. However, this cannot be used individually: the sensitivity and specificity are too low. Either imaging needs to be improved, new methods of looking at the brain developed, or other correlates of cortical microinfarcts are identified. Moreover, hypoperfusion may be an even more important mechanism, as cortical microinfarcts are found in watershed areas prone to hypoperfusion. Understanding the mechanisms of these factors will help us develop new treatments. This interview took place at the AD/PD™ 2022 International Conference on Alzheimer’s and Parkinson’s Diseases hosted in Barcelona, Spain.
