From the Guidelines
Leukoaraiosis, also known as White Matter Disease, refers to the changes in the brain's white matter that appear as areas of abnormal brightness on MRI or CT scans, representing small vessel disease and increasing the risk for stroke, cognitive decline, gait problems, and urinary symptoms. These changes are commonly found in older adults, especially those with vascular risk factors like hypertension, diabetes, and smoking 1. The extent of existing white matter disease, such as leukoaraiosis, has been associated with acute lesion size, degree of lesion expansion, and stroke severity indicated by initial NIHSS score 1.
Key Characteristics of Leukoaraiosis
- Represents small vessel disease
- Commonly found in older adults with vascular risk factors
- Increases risk for stroke, cognitive decline, gait problems, and urinary symptoms
- Associated with acute lesion size, degree of lesion expansion, and stroke severity
Management and Prevention
- Managing underlying risk factors is essential, including:
- Controlling blood pressure (keeping it below 140/90 mmHg)
- Maintaining good glycemic control if diabetic
- Quitting smoking
- Reducing alcohol consumption
- Taking medications like statins if prescribed for high cholesterol
- Regular physical activity (at least 150 minutes per week of moderate exercise) and a Mediterranean-style diet rich in fruits, vegetables, whole grains, and olive oil can help slow progression
- Cognitive stimulation through activities like reading, puzzles, and social engagement may help maintain brain function
Clinical Significance
- Leukoaraiosis is significant because it increases the risk for stroke, cognitive decline, gait problems, and urinary symptoms
- The white matter changes occur because small blood vessels become damaged over time, leading to reduced blood flow and oxygen to brain tissue, resulting in these characteristic white matter lesions that can affect brain connectivity and function 1.
From the Research
Definition and Characteristics of Leukoaraiosis
- Leukoaraiosis (LA) is a radiological term that refers to white matter disturbances observed as a hypodensity in computed tomography and hyperintensity in T2-weighted magnetic resonance image 2.
- It manifests as cerebral white matter hyperintensities on T2-weighted magnetic resonance imaging scans and corresponds to white matter lesions or abnormalities in brain tissue 3.
- LA can present as several heterogeneous forms, including punctate and patchy lesions in deep or subcortical white matter; lesions with periventricular caps, a pencil-thin lining, and smooth halo; as well as irregular lesions, which are not always benign 3.
Clinical Manifestations and Risk Factors
- Leukoaraiosis is associated with cognitive impairment, ranging from mild affectation to dementia, affecting the processing speed and executive functions 2.
- It predisposes to dementia, ischemic stroke, intracerebral hemorrhage, and cognitive decline as well as associates with a significant increase in falls and gait disorders 4.
- The most accepted theory to explain the mechanism of production of leukoaraiosis is chronic ischemia, due to a damage in penetrating arteries 2.
- Vascular risk factors, such as hypertension, play a significant role in the development of leukoaraiosis 5.
Pathogenesis and Vascular Dysfunction
- The pathogenesis of leukoaraiosis has long been debated, with cerebrovascular reactivity playing a potential role in the disease 6.
- Studies have shown that reduced cerebrovascular reactivity is more sensitive than resting blood flow parameters for assessing vascular insufficiency 6.
- Leukoaraiosis is characterized by abnormal resting blood flow metrics and reduced cerebrovascular reactivity in affected areas 6.