In addition to the vascular changes in the cerebral vessels Kraepelin[167] finds usually atheromatous changes in the aorta and its branches, particularly the coronaries, with ulcerations or calcareous plates, hypertrophy and dilatation of the heart, myocarditis, interstitial nephritis and infarctions of various organs. At autopsy the dura and pia are usually thickened and adherent, with a general atrophy of the cerebral convolutions. There are often fresh hemorrhages under the membranes as well as cyst formations and dilatation of the brain ventricles. He particularly emphasizes a splitting of the elastica in the larger cerebral vessels with a thickening and tortuosity, fatty infiltration and calcareous deposits. Hyaline degeneration is common in the elastica and muscularis with fatty granular cells in the adventitia. Capillary aneurysms are often found. Glia proliferation is to be expected in the surrounding area. A condition described by Alzheimer as perivascular gliosis often occurs. There is a disappearance of the perivascular nervous elements with consequent proliferation of the neuroglia. In a general way Kraepelin differentiates several distinct pathological groups—a diffuse cortical involvement, circumscribed processes in the neighborhood of vessels, hemorrhages and softenings. There is also a loss of nerve fibres which are replaced by neuroglia. Binswanger has described a "chronic subcortical encephalitis" due to arteriosclerosis. This consists of an atrophy of the white matter due to an involvement of the deeper marrow vessels. Large gaps and lacunae are found in the course of the vessels. There is an extensive atrophy of the fibres and there may be occasional foci of softening. As a general rule involvement of the large vessels is liable to affect the medullary substance while sclerosis of the smaller vessels leads to cortical disturbances. It is also possible to have extensive lesions without mental symptoms and well developed psychoses with only a slight physical basis. The site of the damage to the vessels determines this. On the other hand, the mental condition may be due to cardiovascular complications resulting usually in anxiety psychoses. The symptomatology may be complicated by senility, alcoholism or syphilis.