Binswanger’s Disease


Alternative Name:
Subcortical vascular dementia.

Definition:
Binswanger’s disease is a form of small vessel vascular dementia caused by damage to the white brain matter. White matter atrophy can be caused by many circumstances including chronic hypertension as well as old age. This disease is characterized by loss of memory and intellectual function and by changes in mood. These changes encompass what are known as executive functions of the brain. It usually presents itself in 54 and 66 years of age, and the first symptoms are usually mental deterioration or stroke.

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A  form of multi-infarct dementia caused by damage to the white brain matter.

Binswanger’s disease is a particular type of atherosclerosis-related dementia, in which there are widespread, microscopic areas of damage to the white matter below the outer layer or cortex of the brain. This is called subcortical dementia and produces a particular pattern of symptoms which is somewhat different to other types of dementia.

The disease may develop gradually or seem to be triggered or rapidly aggravated by a stroke or other event that leads to brain damage.

It was described by Otto Binswanger in 1894, and Alois Alzheimer first used the phrase “Binswanger’s disease” in 1902.  However, Olszewski is credited with much of the modern-day investigation of this disease which began in 1962

Symptoms:
Binswanger’s disease affects the speed at which the brain can process information and this typically causes problems with higher brain functions such as:

•Organisation
•Planning
•Decision making
•Attention
•Concentration (all of which impinge on intellectual function)
•Mood (typically apathy, irritability, and depression)
•Behaviour
Memory loss can occur but is not usually as bad as in other forms of dementia such as Alzheimer’s, while a feature known as psychomotor slowness (where a person takes longer than normal to turn a thought into an action) is common in Binswanger’s disease.

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There may also be changes in speech, an unsteady gait, shaking similar to that seen in Parkinson’s disease, clumsiness or frequent falls and loss of bladder control. These symptoms are not always present in all patients and may sometimes appear only as a passing phase. Seizures may also occur.

Patients usually show other signs of atherosclerosis and cardiovascular disease such as:

•Raised blood pressure
•Stroke
•Blood abnormalities
•Disease of the large blood vessels in the neck
•Disease of the heart valves
Brain scans such as CT scans or magnetic resonance imaging (MRI) show a characteristic pattern in Binswanger’s disease.

Causes:

Atherosclerosis, a disease process that narrows the blood vessels and cuts off the blood supply to the neurons or nerve cells of the brain, causing death of those cells, is a common cause of dementia.

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Binswanger’s disease is a particular type of atherosclerosis-related dementia, in which there are widespread, microscopic areas of damage to the white matter below the outer layer or cortex of the brain. This is called subcortical dementia and produces a particular pattern of symptoms which is somewhat different to other types of dementia.

Diagnosis:

Binswanger’s disease can usually be diagnosed through a CT scan, MRI, and a proton MR spectrography. Indications include infarctions, lesions, or loss of intensity of central white matter and enlargement of ventricles, and leukoaraiosis or white matter atrophy. click & see

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CT Brain Scan showing active NCC (left) and lacunar infarction on the head of the caudate nucleus (right) and lecoara.

Presentation:

Leukoaraiosis (LA) are white matter changes that are common in Binswanger’s Disease. However, LA can be found in many different diseases and even in the general population, especially in people older than 65 years of age.

There is controversy whether LA and mental deterioration actually have a cause and effect relationship. Recent research is showing that different types of LA can affect the brain differently, and that proton MR spectroscopy would be able to distinguish the different types more effectively and better diagnosis and treat the issue.[8] Because of this information, white matter changes indicated by a MRI or CT cannot alone diagnose Binswanger’s disease, but can aid to a bigger picture in the diagnosis process. There are many diseases similar to Binswanger’s disease including CADASIL syndrome and Alzheimer’s disease which makes this specific type of white matter damage hard to diagnose.Binswanger’s disease is best when diagnosed of a team by experts including a neurologist and psychiatrist to rule out other psychological or neurological problems. Because doctors must successfully detect enough white matter alterations to accompany dementia as well as an appropriate level of dementia, two separate technological systems are needed in the diagnosing process.

Technology:

Much of the major research today is done on finding better and more efficient ways to diagnose this disease. Many researchers have divided the MRIs of the brain into different sections or quadrants. A score is given to each section depending on how severe the white matter atrophy or leukoaraiosis is. Research has shown that the higher these scores, the more of a decrease in processing speed, executive functions, and motor learning tasks. Other researchers have begun using computers to calculate the percentage of white matter atrophy by counting the hyper-intense pixels of the MRI. These and similar reports show a correlation between the amount of white matter alterations and the decline of psychomotor functions, reduced performance on attention and executive control. One recent type of technology is called susceptibility weighted imaging (SWI) which is a magnetic resonance technique which has an unusually high degree of sensitivity and can better detect white matter alternations.

Recently a Mini Mental Test (MMT) has been created to accurately and quickly assess cognitive impairment due to vascular dementia across different cultures. Binswanger’s disease has been shown to be the most severe impairment of all of the vascular dementia.


Treatment:

There is no specific treatment for Binswanger’s disease. What treatment there is consists of keeping associated symptoms under control and supporting the patient with their activities of daily living such as dressing, washing and preparing meals.

Medications may be used to treat symptoms such as depression, or generally treat arterial disease and its effects throughout the body (so helping to preserve blood flow to the brain and delay the progression of Binswanger’s).

Specific drugs called “cognitive enhancers” used generally in dementia may be given but the results with them are variable and many people get little benefit.

It has been shown that current Alzheimer’s medication, Aricept, may help Binswanger’s Disease patients as well. Aricept increases the acetocholine in the brain through a choline esterase inhibitor which deactivates the enzyme that breaks down acetocholine. Alzheimer as well as Binswanger patients have low levels of acetocholine and this helps to restore the normal levels of neurotransmitters in the brain. This drug may improve memory, awareness, and the ability to function. If no medical interception of the disease is performed then the disease will continue to worsen as the patient ages due to the continuing atrophy of the white matter from whatever was its original cause.

You may click to see :Homoeopathy and  Binswanger’s disease

Prognosis:
Binswanger’s disease has no cure and patients with the disorder usually die within five years of its onset.
The best way to manage the vascular risk factors that contribute to poor perfusion in the brain is to treat the cause, such as chronic hypertension or diabetes.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:

http://en.wikipedia.org/wiki/Binswanger’s_disease
http://www.bbc.co.uk/health/physical_health/conditions/binswangers_disease.shtml

Binswanger’s disease or Binswager’s Dementia

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijn/vol2n1/bins.xml

http://www.walgreens.com/marketing/library/contents.html?docid=000002&doctype=10

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