Binswanger’s disease is a type of neurologic disorder. It is characterized by degeneration and lesions of the deep white matter of the brain. Binswanger’s disease is a form of vascular dementia. Vascular dementia results when brain cells are deprived of oxygen. This causes brain cells to die.

Causes

Binswanger’s disease occurs when cells of the white matter of the brain degenerate and/or die. This degeneration of the white matter is due to hardening of the blood vessels within the white matter of the brain, which results in a compromise of the blood supply to:

• The brain in general

• The white matter of the brain in particular

The exact cause of Binswanger’s disease is unknown. However, factors that are believed to play a role in causing the disease include:

• High blood pressure, but probably also blood pressure that is too low for proper brain blood supply.

• Cardiovascular disease

• Hardening of blood vessels (atherosclerosis)

• Diabetes

Risk Factors

A risk factor is something that increases your chances of getting a disease or condition. Binswanger’s disease usually affects people over the age of 60. Other exact risk factors for the disease are unknown. However, factors that are believed to increase the risk of the disease include:

• High blood pressure

• Cardiovascular disease

• Hardening of blood vessels (atherosclerosis)

• Diabetes

Symptoms

Symptoms of Binswanger’s disease usually do not appear until age 60. In some patients, symptoms appear suddenly with neurologic changes like those caused by a stroke. Usually, however, symptoms begin slowly and grow progressively worse. Sometimes, symptoms may stabilize or even improve after they appear. However, in most patients, the disease continues to progress.

The main symptoms of Binswanger’s disease include:

• Progressive deterioration of:

• • Intellectual abilities

• • Cognitive and motor abilities

• Progressive memory loss

• Slow, unsteady gait

Other symptoms that may be present in people with this disease include:

• Incontinence

• Difficulty speaking

• Swallowing difficulties

• Paralysis of one side of the body

• Apathy (loss of interest in activities)

• Inactivity

• Depression

• Parkinson-like symptoms, including:

• • Tremors

• • Loss of coordination

• • Loss of trunk mobility

• Seizures

• Strokes

• Confusion

• Paranoia

• Disorientation

Diagnosis

Binswanger’s disease is a form of vascular dementia. Its symptoms can resemble other causes of dementia such as Alzheimer’s disease.

Your doctor will ask about your symptoms and medical history and perform a physical exam. Tests may include:

• MRI Scan–a test that uses magnetic waves to take pictures of your brain

• CT Scan–a type of x-ray that uses a computer to take pictures of your brain

• SPECT (single photon-emission computed tomography)–a test to look for functional degeneration of the white matter in the brain

Treatment

There is no known cure for Binswanger’s disease. Most patients die within 5-10 years after onset of the disease.

Medications can be given to help limit or control symptoms and possibly slow progression of the disease. These include:

• Medications to control:

• • High blood pressure

• • Heart arrhythmias

• • Stroke risk (eg, aspirin)

• • Increased cholesterol

• Antidepressant medications

Prevention

There are no definitive guidelines for the prevention of Binswanger’s disease because the exact cause is unknown. However, the following may help reduce your risk:

• Don’t smoke. If you smoke, quit.

• Eat a diet that is low in fat and low in salt.

• If you drink alcohol, do so only in moderation. Moderate alcohol intake is two drinks per day for men and one drink per day for women.

• Have your blood pressure and blood cholesterol levels checked regularly (at least once per year) , and if treatment is recommended follow your doctor’s guidelines.

• Avoid low blood pressure. If you get dizzy when you stand up or have a history of fainting, be sure to talk with your doctor about ways to ensure a safe amount of blood circulation for your brain at all times.

RESOURCES:

Alzheimer’s Association
http://www.alz.org

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov

National Organization for Rare Diseases
http://www.rarediseases.org

References:

American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html.

Binswanger’s disease–revisited. Neurology. 1995;45: 626-633.

National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov.

Roman GC. Brain hypoperfusion: a critical factor in vascular dementia. Neurol Res. 2004 Jul;26(5):454-8.