Microvascular Ischemic Disease

What is microvascular ischemic disease?

Microvascular ischemic disease is an umbrella term that refers to a variety of changes in the small blood vessels of your brain. Depending on the severity of these changes, they can cause a range of complications — from difficulty focusing to a stroke.

Microvascular ischemic disease has many names, such as:

• Cerebral small vessel disease (CSVD).
• Chronic microvascular ischemic disease.
• Small vessel ischemic disease.

Who does microvascular ischemic disease affect?

Microvascular ischemic disease occurs in older adults, affecting both males and females equally. The chances of having the condition increase with age.

Microvascular ischemic disease affects about 5% of people who are 50 years old. But it affects almost 100% of people older than 90.

How common is microvascular ischemic disease?

Microvascular ischemic disease is a very common condition in older people. According to estimates, it causes 45% of dementia and 25% of strokes.

What causes microvascular ischemic disease?

Microvascular disease results in narrowing of small blood vessels from wall thickening and plaque build-up. Experts aren’t exactly sure what causes microvascular ischemic disease. There are many contributing factors.

What are the risk factors for microvascular ischemic disease?

Advanced age is the main risk factor. But these health issues also increase your risk for developing microvascular ischemic disease:

• Chronic kidney disease.
• Diabetes.
• High blood pressure, particularly 140/90 mm Hg (arterial hypertension).
• High cholesterol.
• Obstructive sleep apnea.
• Smoking or using other tobacco products.

What are the symptoms of microvascular ischemic disease?

Healthcare providers often call microvascular ischemic disease a silent disease. Symptoms may be subtle and often go unnoticed. This is easy to do since people may attribute symptoms to normal signs of aging.

In some older adults, symptoms become moderate or severe. The condition also affects various systems, so symptoms can be wide-ranging, such as:

Bladder

• Inability to control your bladder (urinary incontinence).
• Sudden urge to urinate (urinary urgency).

Cognition (thinking)

• Dementia.
• Difficulty focusing.
• Issues with thinking clearly (mild cognitive impairment).
• Sudden confusion (delirium).

Neurology (nervous system)

• Difficulty swallowing (dysphagia).
• Inability to control facial muscles.
• Inappropriate or uncontrollable outbursts of crying or laughing (pseudobulbar affect).
• Slurred speech (dysarthria).

Mental health

• Anxiety.
• Apathy.
• Depression.
• Fatigue.
• Irritability.

Sleep

• Sleep disorders.
• Trouble sleeping.

Walking

• Balance problems.
• Falls.
• Slow, shuffling walk.

How is microvascular ischemic disease diagnosed?

Healthcare providers typically use magnetic resonance imaging (MRI) to diagnose microvascular ischemic disease. Both are painless imaging tests. It produces clear images of your brain using a large magnet, radio waves and a computer.

Various brain changes occur in microvascular ischemic disease. In your MRI images, healthcare providers may look for these different structural signs:

• Bleeding in your brain’s small blood vessels (cerebral microbleeds).
• Damage to white matter. This appears as bright-white spots on the scan (white matter hyperintensities).
• Small strokes that may not cause neurological symptoms (lacunar infarcts).

Can microvascular ischemic disease be reversed?

It may be possible to reverse some of the brain changes in the early stage of microvascular ischemic disease. But they tend to worsen and become irreversible during the normal course of the disease.

How is microvascular ischemic disease treated?

There aren’t specific treatments for microvascular ischemic disease. Currently, treatment focuses on reducing risk factors and staving off complications, such as dementia and stroke.

Every person will have different risk factors, so treatment is highly personalized. In general, treatment may include:

• Adopting healthy habits, such as exercising and eating more nutrients.
• Quitting smoking.
• Taking medications to lower high blood pressure and regulate cholesterol and glucose levels.

How can I reduce my risk?

It’s important to work with your healthcare provider to pinpoint your specific risk factors and develop a plan.

Some helpful strategies include:

• Eat a diet that includes a variety of nutrients and minimizes salt, saturated fat and sugar.
• Engage in different types of exercise that improve your balance, strength and heart health. It can be useful to work with a physical therapist or fitness trainer. They’ll make sure the exercise is both safe and effective for your specific needs.
• Take part in science-based smoking cessation programs to help you quit. These may include support groups and one-on-one counseling.
• Use stress-reduction and relaxation strategies.

How do I know if I’m at risk?

To know if you’re at risk, pay attention to your symptoms. Stay up to date on your regular checkups and have your bloodwork done. Know your cholesterol levels and blood pressure. If you have underlying conditions such as diabetes or kidney disease, make sure you manage them.

What is the outlook for microvascular ischemic disease?

Untreated microvascular ischemic disease can lead to serious, life-threatening complications. These include stroke and severe cognitive decline. If you follow your personalized treatment plan, you may be able to slow the progression of the condition and lead a healthy, independent life.

When should I see my healthcare provider?

See your healthcare provider for an evaluation if you’re experiencing a dramatic or subtle decline in your ability to:

• Control your bladder.
• Remember things.
• Think clearly.

When should I go to the ER?

Microvascular ischemic disease increases your chance of having a stroke. So, it’s important to go to the emergency room immediately if you’re experiencing sudden:

• Dizziness.
• Inability to talk.
• Loss of balance or coordination.
• Numbness or weakness.
• Severe headache.
• Vision loss in one or both eyes.

A note from Cleveland Clinic

Microvascular ischemic disease can range from mild to severe. It can lead to mood changes and problems with thinking and walking. By addressing your specific risk factors, you can manage or minimize these complications and live a healthier life. Talk to your healthcare provider about developing a personalized plan for you.