From the Research
Management of periventricular hyperintensities (PVH) focuses on addressing underlying vascular risk factors rather than treating the white matter changes directly, with the primary approach involving controlling hypertension with medications such as ACE inhibitors, ARBs, or calcium channel blockers, as supported by the most recent study 1. The primary approach involves controlling hypertension with medications such as ACE inhibitors (like lisinopril 10-40 mg daily), ARBs (such as losartan 25-100 mg daily), or calcium channel blockers (amlodipine 2.5-10 mg daily) 1. Additional management includes:
- Statin therapy (atorvastatin 10-80 mg or rosuvastatin 5-40 mg daily) for hyperlipidemia
- Antiplatelet therapy with aspirin 81-325 mg daily for those with cardiovascular risk factors
- Lifestyle modifications including regular physical exercise (150 minutes of moderate activity weekly), Mediterranean diet, smoking cessation, and limiting alcohol consumption Blood glucose control is essential for diabetic patients, targeting HbA1c below 7% 2. Cognitive rehabilitation may benefit patients with cognitive impairment, and regular neurological follow-up with repeat MRI imaging every 1-2 years helps monitor progression 3. This comprehensive approach is recommended because PVH represent small vessel cerebrovascular disease, and managing vascular risk factors can slow progression and potentially reduce the risk of cognitive decline, stroke, and functional impairment associated with these white matter changes, as highlighted in a recent study on cerebral small vessel disease and cognitive impairment 2. Key points to consider in management include:
- Early detection and management of hypertension and other vascular risk factors
- Regular monitoring of cognitive function and MRI changes
- Comprehensive lifestyle modifications to reduce cardiovascular risk
- Consideration of cognitive rehabilitation for patients with cognitive impairment
- Regular follow-up with a neurologist to monitor disease progression and adjust management as needed, with the most recent study 1 providing guidance on the importance of managing vascular risk factors in patients with PVH.