From the Guidelines
Binswanger's disease, also known as Subcortical Vascular Dementia, is a type of vascular cognitive impairment characterized by damage to white matter deep in the brain due to chronic, inadequate blood flow, and its diagnosis requires the presence of both cognitive impairment and cerebrovascular pathology, as outlined in the Canadian Stroke Best Practice Recommendations, 7th edition 1. The diagnosis of Binswanger's disease involves understanding cognitive abilities through validated cognitive screens and assessments, identifying cerebrovascular pathology through neuroimaging, and determining functional impact through historical individual and collateral information 1. Some key points to consider in the diagnosis and management of Binswanger's disease include:
- The presence of cognitive impairment and cerebrovascular pathology, which can be identified through neuroimaging and cognitive assessments 1
- The importance of managing underlying conditions, such as high blood pressure, atherosclerosis, and diabetes, to slow disease progression
- The use of medications, such as ACE inhibitors, ARBs, or calcium channel blockers, to control blood pressure and prevent further vascular damage
- The role of physical therapy and cognitive rehabilitation in managing mobility issues and cognitive problems
- The need for early diagnosis and aggressive management of vascular risk factors to maintain quality of life for as long as possible 1. It is essential to note that Binswanger's disease is a heterogeneous condition, and its management should be tailored to the individual's specific needs and circumstances, taking into account the latest evidence-based guidelines, such as those outlined in the Canadian Stroke Best Practice Recommendations, 7th edition 1.
From the Research
Definition and Characteristics
- Binswanger's disease, also known as Subcortical Vascular Dementia, is a form of vascular dementia characterized by a specific set of clinical, neuropsychological, and imaging features 2, 3, 4, 5.
- The disease is associated with small vessel disease, hypertensive arteriolopathy, demyelination of the centra semiovale, and deep infarcts 3, 5.
- Patients with Binswanger's disease typically exhibit a progressive course with characteristic pathological changes, including large white matter lesions with axonal damage, blood-brain barrier disruption, and neuropsychological evidence of executive dysfunction 2.
Clinical Profile and Diagnosis
- The clinical profile of Binswanger's disease includes strokes, gait disorder, pseudobulbar signs, and cognitive impairment suggesting dysfunction of the prefrontal cortex 3, 5.
- The diagnosis of Binswanger's disease can be aided by biomarkers, such as cerebrospinal fluid (CSF) and imaging features, including magnetic resonance imaging (MRI) and computed tomography (CT) scans 2, 3, 5.
- A multimodal approach, including clinical, neuropsychological, CSF, and imaging features, can be used to define the Binswanger's disease spectrum disorder 2.
Risk Factors and Prevention
- Hypertension is a major risk factor for Binswanger's disease, as well as other forms of vascular dementia 6, 5.
- Other risk factors include small-artery diseases, such as amyloid angiopathy, impaired autoregulation of cerebral blood flow in the elderly, and periventricular hypoperfusion due to cardiac failure, arrhythmias, and hypotension 5.
- Preventive treatment, such as controlling hypertension, may be effective in reducing the incidence of Binswanger's disease 6, 5.