BINSWANGER DISEASE
Binswanger disease is a progressive form of dementia caused by widespread, microscopic areas of damage to the blood vessels that supply the white matter and affects the deep structure of the brain.
- The white matter is found in the deeper tissue of the brain.
- It contains millions of nerve fibers that connect other parts of the brain and spinal cords and carry nerve impulses between neurons.
- Many of the nerve fibers are protected by a fatty material or sheath called myelin, which gives white matter its color. Myelin also protects the nerve fibers from injury.
- Any damage to the white matter causes the myelin to break down, resulting in problems such as delayed memory, or mental deterioration.
- This progressive neurological disorder develops after age 60 and increases in severity with age.
- This disease is also referred to as subcortical vascular dementia.
- While many dementia results from damage to the cortical portion of the brain, Binswanger disease and some other diseases such as Parkinson’s disease, Alzheimer’s disease, Huntington disease, and dementia associated with AIDS result from damage to the subcortical areas of the brain, especially the subcortical connections.
CAUSES
Binswanger disease is caused by atherosclerosis and thromboembolism, and other diseases that cause an obstruction to the blood vessel supplying the deep structures of the brain.
A narrowing and thickening of the arteries that feed the subcortical portion of the brain may occur. As the arteries become more and more narrowed, blood supplies reduce, and brain tissue dies.
Risk factor for the condition includes:
- Diabetes mellitus
- Hypertension
- Smoking
- Hypercholesterolemia
- Heart disease
- Rare hereditary disease such as CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)
SYMPTOMS
- Forgetfulness
- Changes or difficulty with speech
- Frequent falls
- Urinary problems
- Changes in personality or mood in form of apathy, aggression, depression, or withdrawal from family, friends, and co-workers
- An unsteady gait or poor balance
- Difficulty with swallowing
- Inability to make decisions
- An intellectual impairment such as difficulties to think or reason
- Language difficulties
- Problems reading and writing
- Memory loss
- Confusion
- Exhibit poor judgment
DIAGNOSIS AND TREATMENT
A tentative diagnosis can be made by evaluating patients’ history and symptoms.
A proper diagnosis is made using imaging tests. Brain imaging studies such as CT scan and MRI can detect and reveal characteristic lesions in the tissue located in the inner white matter of the brain, common to Binswanger disease.
TREATMENT
The damage associated with the condition is irreversible. However, treatment options may help to decline or slow the progression of the cognitive decline.
Treatment option may include:
- Managing risk factors that contribute to the condition such as hypertension, or diabetes. A successful management of these conditions can slow down the progression of atherosclerosis, and subsequently slow down the progression of the condition.
- Antidepressants medications such as SSRIs may be recommended for people with anxiety and depression.
- Antipsychotic drugs may be useful in people with agitation and aggressive behavior
Lifestyle changes that can help include:
- Eating a healthy diet
- Regular exercise
- Smoking and drinking cessation
- Keeping a good sleep schedule.