Binswanger's disease

Other names

Subcortical vascular dementia

Pathophysiology

Binswanger's disease (BD) is a type of dementia caused by widespread, microscopic areas of damage to the deep layers of white matter in the brain.

Cause

The damage is the result of the thickening and narrowing (atherosclerosis) of arteries that feed the subcortical areas of the brain.

What is atherosclerosis

Atherosclerosis (commonly known as "hardening of the arteries") is a systemic process that affects blood vessels throughout the body. It begins late in the fourth decade of life and increases in severity with age. As the arteries become more and more narrowed, the blood supplied by those arteries decreases and brain tissue dies.

Diagnosis

A characteristic pattern of BD-damaged brain tissue can be seen with modern brain imaging techniques such as CT scans or magnetic resonance imaging (MRI).

Symptoms

• The symptoms associated with BD are related to the disruption of subcortical neural circuits that control what neuroscientists callexecutive cognitive functioning: short-term memory, organization, mood, the regulation of attention, the ability to act or make decisions, and appropriate behavior.
• The most characteristic feature of BD is psychomotor slowness - an increase in the length of time it takes, for example, for the fingers to turn the thought of a letter into the shape of a letter on a piece of paper.
• Other symptoms include forgetfulness (but not as severe as the forgetfulness of Alzheimer's disease), changes in speech, an unsteady gait, clumsiness or frequent falls, changes in personality or mood (most likely in the form of apathy, irritability, and depression), and urinary symptoms that aren't caused by urological disease.

Tests

Brain imaging, such as an MRI, which reveals the characteristic brain lesions of BD, is essential for a positive diagnosis.

Prognosis

BD is a progressive disease; there is no cure. Changes may be sudden or gradual and then progress in a stepwise manner. BD can often coexist with Alzheimer's disease.

Treatment

• There is no specific course of treatment for BD.
• Treatment is symptomatic.
• People with depression or anxiety may require antidepressant medications such as the serotonin-specific reuptake inhibitors (SSRI) sertraline or citalopram. Atypical antipsychotic drugs, such as risperidone and olanzapine, can be useful in individuals with agitation and disruptive behavior.