Binswanger's disease

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at September 20, 2016
StartBinswanger's disease

Binswanger’s disease, also known as senile dementia of the Binswanger’s type, is a type of small vessel subcortical dementia that is brought on when deep layers of white brain matter and other deep brain structures become damaged. This damage is usually brought on by narrowing of the blood vessels in the brain. This narrowing reduces the blood supply to the subcortical regions and causes the tissue to die. Distinguishing characteristics of this disorder include changes in disposition, memory loss, and a decline in the ability to physically perform common tasks. The disease is progressive in nature and has no cure.

Contents

Definition & Facts

In 1884, Swiss psychiatrist and neurologist, Otto Binswanger was the first to describe the condition that would later be named after him. He noted that lesions in and degeneration of the brain’s white matter caused by the thickening and narrowing of arteries in the subcortical parts of the brain could cause the development of dementia.

After extensive study, this theory was supported in 1902 by Alois Alzheimer, who coined the phrase ‘Binswanger’s disease.’ In the 1960’s, more modern research into the disease was conducted by J. Olszewski. Though vascular dementia had been studied extensively during Binswanger’s time, most cases of subcortical dementia, cortical dementia, and Binswanger’s disease had all been lumped together under the label of ‘senile.’

During Olszewski’s research of prior reports, he uncovered numerous incorrect information and came to the conclusion that Binswanger’s disease was in itself a separate subset of cerebral arteriosclerosis. At one time, Binswanger’s disease was thought to be a rare type of dementia, but with advancements in technology such as the computed tomography (CT) scan, it is now considered one of the more common forms.

Symptoms & Complaints

The onset of symptoms of Binswanger’s usually begin to show when a person is between 54 and 66 years of age. Once symptoms begin to present themselves, it may take between five and ten years before the disease reaches its peak.

The first symptoms that are noticed typically come in the form of the deteriorations of mental abilities or the suffering of a stroke. As the disease progresses, cognitive capabilities continue to decline. This causes patients to experience a loss of short-term memory, the inability to stay focused, and difficulty in making or acting on decisions.

They may also begin to display behavioral changes. Because Binswanger’s disease has a profound affect on cognitive function, the slowing of psychomotor learning is one of the most prominent characteristics. Loss of these skills makes it difficult to move and to remain steady while walking, thus leading to frequent falls.

Difficulty with muscle control often also leads to bladder issues such as incontinence. The loss of the ability to focus makes mundane tasks like making dinner or paying bills almost impossible. Patients with Binswanger’s disease may become easily irritated or may develop a sense of apathy. Frustrated with the decline of their physical and mental abilities, many develop severe depression and become withdrawn and inactive.

Causes

Binswanger’s disease develops when the blood vessels that feed the deep tissue and surrounding structures in the brain become blocked. This decrease in blood flow causes the tissues to begin to deteriorate and become irreversibly damaged. Once this occurs, the onset of dementia follows.

While the source of the damage initiates from clogged blood vessels, the fundamental source causing such blockage can come from many different sources. These can include aspects of the normal aging processes, chronic hypertension, heart disease, diabetes mellitus, and some hereditary diseases. Constriction and blockage of the brain’s blood vessels can also be caused by smoking, poor nutrition, and other lifestyle factors.

Diagnosis & Tests

Typically patients ultimately diagnosed with Binswanger’s disease begin the process at their primary care physician. Usually there will be some sort of complaint dealing with clumsiness or forgetfulness that is out of character for the patient. The physician will begin by going over the patient’s medical history, then will perform a thorough physical examination.

From there, patients will be given a magnetic resonance imaging (MRI) or a computed tomography (CT) scan of the brain to determine the existence of deterioration of white matter. These scans can also determine whether the patient has suffered small strokes in the brain’s deep structures.

Signs of the presence of Binswanger’s disease include lacerations to the white matter, a diminished intensity of white matter and the enlargement of ventricles located in the deep areas of the brain.

The degeneration of the white matter is by itself not enough to give a diagnosis of Binswanger’s. This finding must be coupled with evidence of subcortical dementia and indications of either hypertension or other vascular constriction.

Treatment & Therapy

Binswanger’s disease is a progressive disease that has no cure; therefore, treatment focuses on the relief of symptoms the patient is dealing with as well as reducing the risk of stroke. Each patient may receive a different course of treatment which will typically concentrate on reducing the risk a stroke occurring and controlling symptoms that impede the patient’s quality of life.

Patients exhibiting signs of depression or anxiety may be prescribed antidepressants. Those who display behavior that is aggressive or disruptive may be put on antipsychotic drugs like olanzapine and risperidone. The drug memantine shows promise in improving cognitive function in patients.

Prevention & Prophylaxis

The best way to prevent onset of Binswanger’s disease is to take control of risk factors early in adulthood. Eating a healthy diet, getting plenty of sleep, abstaining from smoking and drinking and getting the recommended amount of exercise can all reduce the risk of developing conditions such as hypertension and diabetes and, in turn, help keep Binswanger’s disease at bay.

For those who already suffer from diabetes and hypertension, management of these diseases is extremely important. Keeping atherosclerosis in control can also slow the progression of Binswanger’s disease that is brought on when deep layers of white brain matter and other deep brain structures become damaged.