From the Guidelines
Leukoaraiosis, also known as white matter disease, is a condition characterized by damage or deterioration of the brain's white matter, which contains nerve fibers (axons) that connect different brain regions, and is associated with an increased risk of incident stroke, mortality, and all-cause dementia, as reported in a recent meta-analysis and systematic review published in 2023 1.
Definition and Prevalence
Leukoaraiosis appears as bright white spots or lesions on MRI scans and is most commonly caused by small vessel disease, where tiny blood vessels deep in the brain become damaged. According to the study published in Alzheimer's and Dementia 1, white matter hyperintensities (WMHs) are increasingly prevalent through midlife and aging, with reports as high as 50.9% in ages 40 to 49 and 96.6% by ages 60 to 69.
Etiology and Pathology
Although the etiology of WMHs is not fully understood, pathological examination reveals varying degrees of myelin loss, axonal rarefaction, edema, perivascular space dilation, gliosis, and microvascular disease, indicative of deteriorating white matter structure, as noted in the study 1. The condition typically develops gradually with aging but can be accelerated by risk factors including hypertension, diabetes, smoking, high cholesterol, and obesity.
Symptoms and Treatment
Symptoms may include cognitive problems, difficulty walking, balance issues, urinary incontinence, and mood changes. Treatment focuses on managing underlying risk factors through blood pressure control, cholesterol management, blood sugar control for diabetics, smoking cessation, regular exercise, and a healthy diet low in salt and saturated fats, as these interventions can slow progression, although there's no cure to reverse existing damage. Physical therapy may help with mobility issues, and cognitive rehabilitation can assist with memory and thinking problems. Regular monitoring with your healthcare provider is essential to track the condition and adjust treatment as needed.
From the Research
Definition and Overview of Leukoaraiosis
- Leukoaraiosis, also known as white matter disease, refers to the changes that occur in the brain's white matter due to small vessel disease 2, 3, 4.
- These changes can be seen on magnetic resonance imaging (MRI) as white matter hyperintensities (WMH) and are associated with cognitive decline and functional impairment in older adults 2, 3.
Pathogenesis and Risk Factors
- The pathogenesis of white matter disease is complex and involves various genetic, metabolic, and vascular risk factors 2, 5.
- Systemic hypertension, particularly 24-hour ambulatory blood pressure, has been identified as a strong indicator of the progression of WMH and associated functional decline 2.
- Other risk factors, such as age, diabetes, and hyperlipidemia, also contribute to the development and accumulation of WMH 3, 4.
Clinical Implications and Diagnosis
- White matter lesions have been implicated in various cerebrovascular conditions, including stroke, dementia, and intracerebral hemorrhage 4.
- Clinical assessment tools, such as MRI, are available for delineating white matter lesions, but their incorporation into clinical decision-making is suboptimal 4.
- Erythrocytes have been identified as an independent protective factor for vascular cognitive impairment in patients with severe white matter hyperintensities 6.
Research and Future Directions
- Further research is needed to understand the pathophysiology of white matter lesions and their role in cerebrovascular diseases 3, 5, 4.
- The development of therapeutic strategies for the prevention and treatment of white matter disease is crucial, and promoting hematopoietic function may have potential value for preventing cognitive decline in patients with cerebrovascular disease 6.