What is Binswanger's Disease?
Binswanger's disease (BD), also called subcortical vascular dementia,
is a type of dementia caused by widespread, microscopic areas of damage to the
deep layers of white matter in the brain. The damage is the result of the
thickening and narrowing (atherosclerosis) of arteries that feed the subcortical
areas of the brain. 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. 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). The symptoms associated with BD are related
to the disruption of subcortical neural circuits that control what
neuroscientists call executive 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. Brain imaging, which reveals the characteristic
brain lesions of BD, is essential for a positive diagnosis.
Is there any 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. Recent drug trials with
the drug memantine have shown improved cognition and stabilization of global
functioning and behavior. The successful management of hypertension and diabetes
can slow the progression of atherosclerosis, and subsequently slow the progress
of BD. Because there is no cure, the best treatment is preventive, early in the
adult years, by controlling risk factors such as hypertension, diabetes, and
smoking.
What is the 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. Behaviors that slow the progression of high blood pressure,
diabetes, and atherosclerosis -- such as eating a healthy diet and keeping
healthy wake/sleep schedules, exercising, and not smoking or drinking too much
alcohol -- can also slow the progression of BD.
What research is being done?
The National Institute of Neurological Disorders and Stroke (NINDS) conducts
research related to BD in its laboratories at the National Institutes of Health
(NIH), and also supports additional research through grants to major medical
institutions across the country. Much of this research focuses on finding better
ways to prevent, treat, and ultimately cure neurological disorders, such as BD.
Organizations
Alzheimer's Disease Education and Referral Center (ADEAR)
P.O. Box 8250
Silver Spring, MD 20907-8250
adear@nia.nih.gov
www.alzheimers.nia.nih.gov
Tel: 301.495.3311 800.438.4380
Fax: 301.495.3334
Alzheimer's Association
225 North Michigan Avenue, 17th Floor
Chicago, IL 60601-7633
info@alz.org
www.alz.org
Tel: 312.335.8700 1.800.272.3900 (24-hour helpline) TDD: 312.335.5886
Fax: 866.699.1246
American Heart Association
7272 Greenville Avenue
Dallas, TX 75231-4596
inquiries@heart.org
www.americanheart.org
Tel: 800.AHA.USA1 (242.8721) 214.373.6300
Family Caregiver Alliance/ National Center on Caregiving
180 Montgomery Street, Suite 1100
San Francisco, CA 94104
info@caregiver.org
www.caregiver.org
Tel: 415.434.3388 800.445.8106
Fax: 415.434.3508
National Organization for Rare Disorders (NORD)
P.O. Box 1968
(55 Kenosia Avenue)
Danbury, CT 06813-1968
orphan@rarediseases.org
www.rarediseases.org
Tel: 203.744.0100 Voice Mail 800.999.NORD (6673)
Fax: 203.798.2291
National Stroke Association
9707 East Easter Lane, Suite B
Centennial, CO 80112-3747
info@stroke.org
www.stroke.org
Tel: 303.649.9299 800.STROKES (787.6537)
Fax: 303.649.1328
Source: National Institutes of Health; National Institute of
Neurological Disorders and Stroke
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 8/7/2009...#6016
