From the Guidelines
White matter disease is a condition characterized by the deterioration of white matter in the brain, often associated with cerebral small vessel disease, and is a significant predictor of cognitive decline, stroke, and mortality. This condition is marked by the presence of white matter hyperintensities (WMHs) on neuroimaging studies, which are highly prevalent in midlife and aging populations, affecting up to 96.6% of individuals between 60 to 69 years old 1. The etiology of WMHs is not fully understood, but pathological examination reveals myelin loss, axonal rarefaction, edema, and microvascular disease, indicative of deteriorating white matter structure 1.
Key Features of White Matter Disease
- High prevalence in midlife and aging populations
- Associated with cerebral small vessel disease
- Characterized by white matter hyperintensities on neuroimaging studies
- Linked to increased risk of incident stroke, mortality, and all-cause dementia 1
- Symptoms can include problems with walking, balance, memory, thinking, and mood changes
Management and Prevention
Early intervention to address risk factors, such as hypertension, diabetes, and smoking, is crucial to minimize the impact of white matter disease on brain function and quality of life. Adopting a heart-healthy lifestyle, including regular exercise, a healthy diet, and not smoking, can help slow disease progression 1. Treatment focuses on managing underlying conditions and sometimes medications to address specific symptoms. Controlling cardiovascular risk factors is essential to reduce the risk of cognitive decline and vascular dementia associated with white matter disease 1.
From the Research
Definition of White Matter Disease
White matter disease refers to the damage or microstructural alterations of the white matter in the brain, which can cause dysfunction of the intrinsic neural networks 2. It is commonly detected on brain computed tomography and magnetic resonance imaging scans.
Causes and Risk Factors
The causes of white matter disease can be vascular or demyelinating in origin 2. Vascular risk factors, such as hypertension and diabetes, have been shown to be associated with white matter hyperintensities (WMH) 3, 4, 5. Other risk factors include age, reduced renal function, and duration of hypertension 5.
Characteristics and Diagnosis
White matter hyperintensities (WMH) appear as lesions on T2-weighted magnetic resonance imaging (MRI) scans of the brain 4. The presence and severity of WMH can be assessed using various grading systems, such as Fezeka's and Pasquier grading 3. Early and accurate diagnosis of white matter disease is important to ensure timely treatment and management.
Impact on Cognitive Decline
White matter disease has been shown to be a key component of cerebrovascular disease impacting cognitive decline 6. White matter changes, including WMH and diffusion changes, can predict future cognitive decline across all domains 6. The vascular summary score, which includes white matter changes and microbleeds, can explain variability in cognitive performance equivalent to the impact of amyloidosis on cognition 6.
Key Findings
- White matter disease is a common condition that can cause cognitive decline and dementia 4, 6.
- Vascular risk factors, such as hypertension and diabetes, are associated with white matter hyperintensities (WMH) 3, 4, 5.
- White matter changes, including WMH and diffusion changes, can predict future cognitive decline across all domains 6.
- Early and accurate diagnosis of white matter disease is important to ensure timely treatment and management 2.