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.
Alzheimer's Disease Education and Referral Center (ADEAR)
National Institute on Aging P.O. Box 8250 Silver Spring, MD 20907-8250 Toll-free: 800.438.4380 Fax: 301.495.3334 Email: Website: www.nia.nih.gov
225 North Michigan Avenue, 17th Floor Chicago, IL 60601-7633 Phone: 312.335.8700 Toll-free: 800.272.3900 (24-hour helpline) TDD: 312.335.5886 Fax: 866.699.1246 Email: Website: www.alz.org
American Heart Association
7272 Greenville Avenue Dallas, TX 75231-4596 Phone: 214.373.6300 Toll-free: 800.AHA.USA1 (242.8721) Email: Website: www.heart.org/HEARTORG
Family Caregiver Alliance/ National Center on Caregiving
785 Market St., Suite 750 San Francisco, CA 94103 Phone: 415.434.3388 Toll-free: 800.445.8106 Fax: 415.434.3508 Email: Website: www.caregiver.org
National Organization for Rare Disorders (NORD)
55 Kenosia Avenue Danbury, CT 6810 Phone: 203.744.0100 Voice Mail: 800.999.NORD (6673) Fax: 203.798.2291 Email: Website: www.rarediseases.org
National Stroke Association
9707 East Easter Lane, Suite B Centennial, CO 80112-3747 Phone: 303.649.9299 Toll-free: 800.STROKES (787.6537) Fax: 303.649.1328 Email: Website: www.stroke.org
*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: 5/16/2012...#6016