White Matter Disease

What is white matter disease?

White matter disease is an umbrella term for changes and damage to your brain’s white matter — the nerve fibers in your brain that connect different areas of your brain to each other and to your spinal cord like highways.

You can also get white matter disease, also called cerebral small vessel or microvascular disease, from aging and blood vessel changes in your brain’s white matter. It can be mild, moderate or severe.

When your white matter becomes damaged, it causes white matter lesions, which healthcare providers can “see” as bright spots on magnetic resonance imaging (MRI) of your brain. Some white matter lesions may not cause noticeable symptoms and can be considered almost “normal” with aging. However, some of these lesions can damage important pathways (highways) within your brain and can cause problems with memory, balance and walking.

In general, people with more white matter lesions (more significant white matter disease) experience more symptoms.

White matter disease is strongly linked to cardiovascular disease risk factors, and researchers believe that white matter disease is a biomarker (medical sign) of the lifelong risk of stroke, dementia and disability.

What is white matter?

White matter is made up of a large network of nerve fibers (axons) in your brain that allows the exchange of information and communication between different areas of your brain. It’s called “white matter” because the nerve fibers are covered in a protective sheath called myelin, which gives the tissue its white color.

The surface and deep areas of your brain contain gray matter, which gets its color from the cell bodies of neurons.

For your white matter to be healthy, it needs good blood flow and nutrients.

Decreased blood flow (ischemia) and nutrients to the white matter can cause damage to these nerve fibers (axons) including swelling, breaking and complete loss. Just as your lawn may not look healthy without watering and nutrients (sunlight and fertilizer), your brain can get damaged with poor blood flow and an unhealthy diet.

Who does white matter disease affect?

White matter disease can affect anyone, but it’s more common in people 60 years of age and older and in people who have cardiovascular disease.

While a few white matter lesions can be seen with a brain MRI in younger people with conditions like migraine, getting older and having more uncontrolled risk factors for cardiovascular disease increases your likelihood of having more white matter lesions.

In some people, genetic risk factors can increase the chances of having white matter disease.

How common is white matter disease?

White matter disease is common. It’s present in more than half of the population of people who are 60 years old.

What are the symptoms of white matter disease?

Signs and symptoms of white matter disease include:

• Memory problems.
• Slow walking.
• Balance issues and frequent falls.
• Difficulty performing two or more activities at once, such as walking and talking at the same time.
• Mood changes, such as depression.
• Urinary incontinence.

These signs and symptoms may be worse in people who have more advanced (severe) white matter disease.

While people can experience many of these signs and symptoms as normal changes with aging and other medical conditions (like arthritis, diabetes-associated neuropathy, Alzheimer’s dementia and poor sleep), a rather quick onset and progression of these symptoms may be cause for concern.

Sometimes white matter disease is detected when getting a brain MRI for other reasons. In some people, white matter disease may not cause symptoms (asymptomatic). You should discuss with your healthcare provider whether your symptoms could be due to white matter disease or other causes.

What causes white matter disease?

Researchers are still learning about white matter disease and its cause. So far, they think it’s caused by chronically reduced blood flow to nerve fibers in white matter, which can cause damage to the fibers.

With aging, your arteries become hard and have more difficulty stretching (lose elasticity). This can lead to less blood flow to nerves in your brain, causing damage to your white matter.

White matter disease can also be caused by atherosclerosis, which is the thickening and hardening of the walls of your arteries that happens due to the buildup of plaque in your arteries over time. It can affect any arteries in your body, including ones in your brain.

Having cardiovascular risk factors, such as high blood pressure, elevated blood sugar (from diabetes), high dietary fat intake (high cholesterol) and smoking can all increase the number of white matter spots or lesions in your brain.

Other causes of white matter lesions

Any process leading to a change in the chemical composition of, damage to or decreased blood flow (ischemia) of myelinated fibers can present as white matter lesions on magnetic resonance imaging (MRI).

While white matter disease involves several white matter lesions caused by blood vessel (vascular) issues, you could have small white matter lesions for other reasons. Lesions are common features of non-vascular conditions, including demyelinating inflammatory disorders, such as multiple sclerosis, and genetic causes like leukodystrophy.

Healthcare providers such as neurologists and neuro-radiologists are often able to distinguish white matter disease lesions from other causes of lesions with MRI based on where they’re located in your brain. Sometimes additional testing is necessary to help determine the cause of the white matter lesions on your MRI.

How is white matter disease diagnosed?

Brain magnetic resonance imaging (MRI) is the main way healthcare providers diagnose white matter disease. An MRI scan is a painless test that produces very clear images of different parts of your body. MRI uses a large magnet, radio waves and a computer to produce these detailed images without any radiation (does not use X-rays).

Brain MRI scans allow healthcare providers to see the extent of white matter damage in your brain and to diagnose white matter disease.

White matter changes are visible on magnetic resonance imaging (MRI) as lesions. An MRI report can call white matter changes a few different things, including:

• Cerebral or subcortical white matter disease or lesions.
• Microvascular disease.
• Non-specific white matter changes.
• T2 hyperintensities (lesions).

In some cases, your provider might see signs of white matter disease in your MRI results that you underwent for a different medical reason. In other cases, your provider may order an MRI if nothing else explains your symptoms, such as balance and memory issues.

While there are other types of imaging tests, such as CT (computed tomography) scans, MRI has the best imaging quality and sensitivity for diagnosing white matter disease.

Your provider may also perform a neurological exam to assess your symptoms when diagnosing white matter disease.

Since white matter disease is associated with cardiovascular disease risk factors, your provider may also order the following blood tests to assess your risk:

• Comprehensive metabolic panel.
• Lipid panel.
• Glycosylated hemoglobin test (HbA1c).

How is white matter disease treated?

Healthcare providers focus treatment for white matter disease on managing symptoms and the risk factors associated with cardiovascular disease.

Treating underlying health issues like high blood pressure, diabetes and high cholesterol as well as quitting smoking can help prevent more white matter lesions from forming.

While there are no treatments to repair white matter that’s already been damaged, people with more uncontrolled health problems generally experience greater white matter damage and disability.

Treatment for white matter disease symptoms

Physical therapy may help with balance and walking problems caused by white matter disease, including education and therapy to prevent falls.

Seeing a psychologist to talk about problems with depressed mood and seeing a psychiatrist for medications like antidepressants can help with symptoms of depression.

There are several treatments for managing urinary incontinence, including medications, lifestyle changes and procedures.

Managing cardiovascular disease risk factors

Managing the risk factors associated with cardiovascular disease can help slow the progression of white matter disease — and help prevent life-threatening cardiovascular conditions like strokes.

Treatments that can help manage cardiovascular disease risk factors include:

• Medications and lifestyle changes to maintain healthy blood pressure.
• Management of diabetes (if you have diabetes).
• Managing cholesterol levels with medication and lifestyle changes.
• Regularly exercising.
• Avoiding smoking.
• Avoiding alcohol.
• Antiplatelet medications (a group of medicines that stop blood cells from sticking together and forming a blood clot).
• Statins (these can help reduce inflammation in blood vessels even if your cholesterol is normal).

What kind of doctor treats white matter disease?

Depending on your symptoms and situation, you may see any combination of the following healthcare providers to treat the symptoms of white matter disease and monitor its progression:

• Neurologist.
• Primary care provider.
• Physical therapist.
• Occupational therapist.
• Physical medicine and rehabilitation provider (physiatrist).
• Cardiologist.
• Urologist.
• Psychologist and/or psychiatrist.

Can white matter disease be prevented?

Studies show that people who have risk factors for cardiovascular disease also have a greater risk of developing white matter disease.

Risk factors for cardiovascular disease include:

• High blood pressure (hypertension).
• High cholesterol (hyperlipidemia, dyslipidemia).
• Smoking.
• Poorly managed diabetes.

There are steps you can take to try to slow down its progression. Studies show that managing these risk factors by taking medication, making lifestyle changes and/or quitting smoking can help prevent more white matter lesions from forming.

What is the prognosis (outlook) for white matter disease?

White matter disease is a spectrum that can appear on MRI as mild to severe. Symptoms associated with it can range from nonexistent to severe. Because of this, the prognosis (outlook) for white matter disease varies from person to person.

If you’ve been diagnosed with white matter disease, talk to your neurologist about what you can expect.

When should I see my healthcare provider about white matter disease?

If you’ve been diagnosed with white matter disease, it’s important to see your primary care physician regularly to discuss managing your risk factors. Depending on the nature and severity of the white matter disease and your symptoms, you may need to see additional specialists.

A note from Cleveland Clinic

If you’ve been diagnosed with white matter disease, it’s essential to prioritize your cardiovascular health, such as taking medications and making lifestyle changes to manage your cholesterol levels and blood pressure. Doing so can help prevent new white matter lesions and help reduce your risk for stroke and dementia. If you have any questions about this condition or cardiovascular disease risk factors, ask your healthcare provider. They’re available to help.