Binswanger disease (BD) is a distinct form of vascular dementia in which atherosclerosis and hypertension affecting the smaller blood vessels in the white matter cause a slowly progressive ischemia of the subcortical areas of the brain[1] [2] [3]. Hypertensive vascular disease is, by far, the single most important risk factor for the development of BD, and many individuals report prior episodes of stroke or transient ischemic attacks (TIAs), whereas diabetes mellitus, pre-diabetic states, cigarette smoking, hyperlipidemia and sleep apnea are mentioned in certain reports as well [1] [4]. Progressive reduction of blood flow through these areas explains the gradual course of BD, and the initial symptoms are related to alterations in cognitive status - decline in executive functions, reduction in the speed of processing information and memory dysfunction [1] [2] [5] [6]. Moreover, deficits in attention, behavioral changes and emotional lability are clinical hallmarks of BD and other forms of dementia [3] [5]. In addition, focal neurological deficits are commonly observed, most prominent being those involving the upper motor neurons (UMNs) - muscle rigidity, hyperreflexia (often asymmetric), signs of parkinsonism, ataxia and gait disturbances [1] [2] [3] [6]. Urinary incontinence is reported in many individuals as well [4] [6].

• Progressive Dementia

  The other 15 patients had neurologic deficits that presented in one of three ways: (1) stroke, seven patients; (2) slowly progressive dementia and gait disturbance, five patients; or (3) slowly progressive dementia alone, three patients. [jamanetwork.com]

  The main clinical manifestations of progressive dementia. 【clinical points] 1. 2/3. chronic disease, and 1/3 for the acute onset. [e.uuuwell.com]

  Intermittent and fluctuating neurological signs - often appearing at intervals of several years - as well as a slowly progressing dementia, can be a clinical indication of SAE, especially in patients who have been known to suffer from hypertension for [thieme-connect.com]

  A patient with long term severe hypertension develops progressive dementia. Risk Factors Hypertension Diagnosis CT CT scans of the head demonstrates a diffuse loss of deep hemispheric white matter. [wikidoc.org]

  Lewy Body Dementia Lewy body dementia (LBD) is one of the most common types of progressive dementia. Symptoms of Lewy body dementia overlap with those of other diseases, making it hard to diagnose. [alzheimersweekly.com]

• Difficulty Walking

  Symptoms include depression, muscle rigidity, difficulties walking and urinary incontinence. There is no cure for the condition. [sciencephoto.com]

  Other prominent features of the disease include urinary incontinence, difficulty walking, parkinsonian-like tremors, and depression. [ucl.ac.uk]

  Other prominent features of the disease include urinary incontinence, difficulty walking, clumsiness, slowness of conduct, lack of facial expression, and speech difficulty. [prep4usmle.com]

  The abnormality of gait that may occur in patients with subcortical arteriosclerotic encephalopathy is described in 12 patients in whom difficulty walking was the presenting symptom. [medigoo.com]

  Symptoms often include slowness and lethargy, difficulty walking, emotional ups and downs and lack of bladder control early in the course of the disease. Most people with Binswanger's disease have, or have had, high blood pressure. [dementia.org.au]

• Rigor

  The need for rigorous demonstration of a focal clinical deficit, for a precise time of onset of symptoms ( Other modes of therapy, which have some rationale, but are unproved in efficacy, aim at relatively or absolutely increasing the collateral blood [dartmouth.edu]

• Hypotension

  This pallor can only be due to cerebral edema, most likely of hypoxic-ischemic, hypotensive, or acidotic origin. We also contend that arteriosclerosis can only cause dementia through multiple infarcts or lacunae, if it indeed leads to dementia. [ncbi.nlm.nih.gov]

  There is also the importance of persistent cough, surgical interventions, orthostatic arterial hypotension due to vegetative-vascular insufficiency. [iliveok.com]

  On the basis of severe arteriosclerosis in the cerebral arteries, it was speculated that repeated hypotension or greater variability of casual blood pressure could induce PSVE in the elderly hypertensives. [jstage.jst.go.jp]

  Pervasive Developmental Disorders Phytanic Acid Storage Disease Pick’s Disease Pinched Nerve Piriformis Syndrome Pituitary Tumors Polymyositis Pompe Disease Porencephaly Postherpetic Neuralgia Postinfectious Encephalomyelitis Post-Polio Syndrome Postural Hypotension [gncdubai.com]

  There are numerous risk factors underlying these changes, such as age, hypertension, hypotension, smoking, inadequate diet, and diabetes mellitus. A number of genetic factors may also play a role. [medigoo.com]

• Heart Disease

  People who smoke, consume excessive amounts of alcohol, have diabetes, or heart disease also have a higher rate of the condition. Vascular dementia most commonly occurs in people between the ages of 60 and 75. [webmd.com]

  These findings may have important implications for preventative strategies, suggesting that reducing vascular risk factors could reduce risk for both Alzheimer’s disease and vascular dementia, in addition to heart disease. [dementia.org.au]

  Hypertension, smoking, hypercholesterolemia, heart disease and diabetes mellitus are risk factors for Binswanger disease. [rarediseases.org]

  Patients are treated symptomatically, i.e., treated for the symptoms such as high blood pressure, seizures, or heart disease often associated with Binswanger disease. [encyclopedia.com]

  […] other conditions that reduce blood flow to the brain, including certain autoimmune diseases (e.g., lupus eythematosus, temporal arteritis), certain inherited (genetic) diseases, infections of the heart (endocarditis), brain hemorrhage, and profoundly [dementiacarecentral.com]

• Orthostatic Hypotension

  Hypotension O’Sullivan-McLeod Syndrome Overuse Syndrome Pain – Chronic Pantothenate Kinase-Associated Neurodegeneration Paraneoplastic Syndromes Paresthesia Parkinson’s Disease Paroxysmal Choreoathetosis Paroxysmal Hemicrania Parry-Romberg Pelizaeus-Merzbacher [gncdubai.com]

  The association of orthostatic hypotension and white matter lesions found by the CHS study 1 further corroborates the importance of these seldom-mentioned morphological alterations in the genesis of deep white matter lesions. [stroke.ahajournals.org]

  hypotension sudden drop in blood pressure experienced upon standing up orthotic mechanical appliance such as a leg brace or splint that is designed to control, correct, or compensate for impaired limb function oscillopsia visual disturbance characterized [strokecenter.org]

• Delusion

  2012 ICD-9-CM Diagnosis Code 290.12 Presenile dementia with delusional features Short description: Presenile delusion. [icd9data.com]

  Cognitive deficits of patients with Alzheimer’s disease with and without delusions. Am J Psychiatry 1992;149:184-189. 8. Lachs MS, Becker M, Siegal AP et al. Delusions and behavioral disturbances in cognitively impaired elderly persons. [infodoctor.org]

  The condition can be alleviated, and repeated exacerbations. 2. mainly clinical slowly progressive dementia, memory, cognitive dysfunction, emotional, and personality changes, apathy, delusions, the mildly neurotic disorders. 3. recurrent focal symptoms [e.uuuwell.com]

  […] getting lost in familiar surroundings Laughing or crying at inappropriate times Trouble concentrating, planning, or following through on activities Trouble managing money Inability to follow instructions Loss of bladder or bowel control Hallucinations or delusions [webmd.com]

  They also lose their ability to solve problems and maintain emotional control, and they may experience personality changes and behavioral problems such as agitation, delusions, and hallucinations. [alzheimersweekly.com]

• Euphoria

  Patients may become emotionally labile and unpredictable, demonstrating euphoria or aggression. Severe depression occurs in 20 percent of cases, and suicide attempts have been reported. [aafp.org]

• Urinary Incontinence

  Clinically, Lacunar Dementia presents with gait difficulties, urinary incontinence, parkinsonian features, pseudobulbar palsy, emotional incontinence and dementia. [ncbi.nlm.nih.gov]

  Symptoms include depression, muscle rigidity, difficulties walking and urinary incontinence. There is no cure for the condition. [sciencephoto.com]

  […] the cardiovascular system Arteriosclerosis of small cerebral arteries Abnormality of the genitourinary system Urinary incontinence Abnormality of the integument Alopecia Abnormality of the nervous system Arteriosclerosis of small cerebral arteries Ataxia [familydiagnosis.com]

  Urinary incontinence is reported in many individuals as well. To diagnose BD, a detailed patient history is the first step in the workup. The course and progression of symptoms are noted in the history. [symptoma.com]

• Stroke

  Gain fresh perspectives and up-to-date insights from the world’s leading authorities on the pathophysiology, diagnosis, and management of stroke. [books.google.de]

  Strokes take place when the supply of blood carrying oxygen to the brain is suddenly cut off. However, not all people with stroke will develop vascular dementia. Vascular dementia can occur over time as "silent" strokes pile up. [webmd.com]

  Patients usually show signs of abnormal blood pressure, stroke, blood abnormalities, disease of the large blood vessels in the neck, and disease of the heart valves. [ucl.ac.uk]

  The prognosis of LI strokes is benign in the initial follow up period (30 days post-stroke or 1 year after stroke) [ 27 ]. [academic.oup.com]

  The clinical picture in 11 patients was characterized by: (1) persistent hypertension and systemic vascular disease; (2) acute strokes; (3) subacute accumulation of focal neurologic symptoms and signs over weeks to months; (4) long plateau periods; (5 [ncbi.nlm.nih.gov]

• Encephalopathy

  The pathogenesis of subcortical arteriosclerotic encephalopathy is unknown; possible mechanisms include diffuse ischemia and fluid transudation with subsequent gliosis related to subacute hypertensive encephalopathy. [ncbi.nlm.nih.gov]

  Subcortical Encephalopathy, Binswanger's Disease (BD). [xpertdox.com]

  Fisher CM (1989) Binswanger's encephalopathy: a review. J Neurol 236:65–79 Google Scholar 10. Fukatake T, Hattori T, Kita K, Hirayama K (1985) Familial juvenile encephalopathy (Binswanger type) with alopecia and lumbago-A syndrome. [link.springer.com]

• Cognitive Impairment

  We also examined the indices of cognitive impairment and brain atrophy. In each group, the ventricular area-cranial space area ratio was measured by an image analyzer. [ncbi.nlm.nih.gov]

  Overview Subcortical vascular cognitive impairment, characterized by subcortical and executive cognitive dysfunction, is now recognized to be the most common form of vascular cognitive impairment. [medlink.com]

  VCI, vascular cognitive impairment, not yet dementia. [academic.oup.com]

  It demonstrates the underlying causes of the disorder, such as the manner in which vascular risk-factors influence the onset of vascular cognitive impairment. [books.google.es]

  Therefore, elucidating the distinctively impaired patterns of brain structures in BD and AD will help to identify the pathological substrates of cognitive impairments. [journals.plos.org]

• Seizure

  Abnormal electrical disturbances in the brain may cause seizures. Binswanger's symptoms may be elusive in both appearance and degree. [encyclopedia.com]

  […] dementia and was first described in 1894.The illness occurs mainly in middle-aged hypertensive patients who show evidence of systematic vascular disease and who develop insidious fluctuating dementia with special involvement of memory, mood and cognition; seizures [alzheimer-europe.org]

  Seizures may also be present. [ucl.ac.uk]

  (petit mal seizure) generalized seizure characterized by abrupt cessation of ongoing activity with a blank stare and lost or impaired consciousness lasting on average 10-20 seconds abulia loss of will, impulse, and decision-making ability acalculia " [strokecenter.org]

  Clinton suffers from “Dementia, Seizures and Black-outs.” In fact, the Doctor made note that Clinton’s conditions are “considerably worse” than in 2013. [globalresearch.ca]

• Apathy

  Patients with this disease usually present with apathy, agitation, and bilateral corticospinal or bulbar signs Tags: binswanger', s-disease, subcortical-dementia, white-matter-atrophy 1000 chars left No comments found. [medicalvideos.com]

  Other symptoms include forgetfulness (but not as severe as the forgetfulness of Alzheimer's disease), changes in speech, an unsteady gait, clumsiness or frequent falls, changes in personality or mood (most likely in the form of apathy, irritability, and [ninds.nih.gov]

  Synonyms Subacute arteriosclerotic encephalopathy Symptoms and course forgetfulness disorientation slowness of thought apathy lack of emotion depression aggression mild intellectual impairment (difficulties to think or reason) language difficulties problems [alzheimer-europe.org]

  Depending on where the lesion is located, there could be apathy or other behavioral changes instead. There could also be Parkinson-like changes, like facial weakness and arm drift. [randombio.com]

  Other symptoms include: forgetfulness (but not as severe as the forgetfulness of Alzheimer's disease ), changes in speech, an unsteady gait, clumsiness or frequent falls, changes in personality or mood (most likely in the form of apathy, irritability, [rxlist.com]

To diagnose BD, a detailed patient history is the first step in the workup. The course and progression of symptoms are noted in the history. If patients give unreliable data regarding their illness, a heterogeneous anamnesis from either family members of close friends can be highly useful in obtaining an objective view about the condition of the patient. History of cardiovascular disease and the presence of additional risk factors and comorbidities is integral in order to make a presumptive diagnosis. The second step is a meticulous physical examination, with an emphasis on cognitive assessment and neurological examination, both equally important procedures when there is a clinical suspicion of any type of dementia. The Montreal Cognitive Assessment (MOCA), preferred over the mini-mental status examination (MMSE) is recommended for evaluation of cognitive function [1] [7]. Once valid clinical criteria for dementia are noted, the diagnosis of BD can be confirmed with imaging studies, especially magnetic resonance imaging (MRI) [1] [2] [3] [5] [7]. One of the most important features of BD on MRI are 5-10 mm lacunar infarcts, principally located in the brain stem and the majority of the white matter with signs of atrophy [1] [4]. Together with lacunar infarcts, hyperintensity of the white matter (known as leukoaraiosis), usually in the periventricular space, is diagnostic for BD [1] [4] [6]. In addition to MRI, computed tomography (CT) can also identify leukoaraiosis, and is preferred over MRI in certain circumstances [1] [4] [6].

• Fibrinoid Necrosis

  Severe hypertension --> vasospasm and ischemia of vascular wall which causes necrosis or proliferation leading to fibrinoid necrosis or hyperplastic arteriolosclerosis respectively You can also see microinfarctions and microhemorrhages ( flea-bitten kidney [quizlet.com]

  Lipohyalinosis (fibrinoid necrosis & hyalinisation)= vessens between 40-300 mm in diameter. Related articles: Ischemic stroke, Approach to cognitive impariment, Approach to acute confusion “altered mental status” , [learningneurology.com]

  In Binswanger disease, vascular changes observed are fibrohyalinosis of the small arteries and fibrinoid necrosis of the larger vessels inside the brain. [emedicine.medscape.com]

  Hypertensive Arteriopathy The microangiopathy associated with arterial hypertension has been well studied, particularly in the context of lacunar strokes. 34 35 36 Microatheromata, lipohyalinosis, and fibrinoid necrosis characterize the arteriopathy of [stroke.ahajournals.org]

  […] aneurysm small saccular aneurysm of an intracranial artery Binswanger’s disease (subcortical leukoencephalopathy) degenerative white matter disease producing dementia due to hypertensive microvascular changes lipohyalinosis of the small arteries and fibrinoid [strokecenter.org]

In 1 out of these 4 patients, treatment with sodium ozagrel, an antiplatelet drug was applied, but was ineffective. [ncbi.nlm.nih.gov]

Because there is no cure, the best treatment is preventive, early in the adult years, by controlling risk factors such as hypertension, diabetes, and smoking. × Treatment There is no specific course of treatment for BD. Treatment is symptomatic. [ninds.nih.gov]

It examines the differential neuropathological and pathophysiological bases of these dementias and emphasizes their behavioral and cognitive aspects in assessment, diagnosis, and treatment. [books.google.de]

There are very less treatments are available on binswanger's disease but the best treatment is prevention. The medication control high blood pressure, heart arrhythmias, stroke risk, high cholesterol and antidepressant medications. [depression-guide.com]

Prognosis BD is a progressive disease; there is no cure. Changes may be sudden or gradual and then progress in a stepwise manner. BD can often coexist with Alzheimer's disease. [ninds.nih.gov]

Prognosis for People With Vascular Dementia If the conditions that cause vascular dementia go untreated, the prognosis is not good. [webmd.com]

Prognosis for People With Binswanger's Disease Binswanger's disease is a slowly progressive condition for which there is no cure. Changes may be sudden or gradual and then progress in a stepwise manner. [alzheimers.emedtv.com]

Treatment and Prognosis There is no cure for Binswanger's Disease. However, taking good care of your heart and your brain can delay or slow the progression of the cognitive decline. Who Was Dr. Binswanger? Dr. [verywell.com]

Prognosis of Binswanger's Disease It is slowly improving condition in which there is a less possibility of to cure the disease. The persons die within the 5 year. Some drugs are used to cure high and low blood pressure, depression. [depression-guide.com]

The etiology is considered to be vascular and to represent a special course of arteriosclerosis. [ncbi.nlm.nih.gov]

Secondary (10%) These can then be broken into chronic or hypertensive crisis (urgency vs. emergency) What are 6 etiologic factors in essential htn? 1. Increased sympathetic tone 2. Genetic abnormalities in Na+ metabolism 3. Excessive Na+ intake 4. [quizlet.com]

Due to their vascular etiology, the symptoms and physical findings associated with Binswanger disease may suddenly worsen due to stroke, stabilize and then improve for a brief time, but the patient's overall condition continues to progress as the blood [rarediseases.org]

"Blood Pressure" [SH] (epidemiology AND humans) [SH] SI Secondary Source ID The SI field identifies secondary source databanks and accession numbers, e.g., GenBank, GEO, PubChem, ClinicalTrials.gov, ISRCTN. [biomedsearch.com]

Epidemiology of Binswanger’s Disease Binswanger’s disease affects both males and females equally. It is commonly seen in individuals above 50 years of age. [epainassist.com]

Family history of stroke or cardiovascular disease Epidemiology VaD is the second most common form of dementia in the West after Alzheimer's disease. It is the most common form in some parts of Asia. Incidence increases with age. [patient.info]

Cerebrovascular Diseases 45(5-6) 258-262 2018年 [査読有り] Linking atrial fibrillation with Alzheimer's disease: Epidemiological, pathological, and mechanistic evidence Ihara M, Washida K. [researchmap.jp]

[…] record: 3301 elderly participants in the Cardiovascular Health Study (CHS). 1 In these times of budget reduction, the CHS may become—along with the Framingham study—a lasting monument to the scientific and public health benefits of the type of mega-scale epidemiological [stroke.ahajournals.org]

Gain fresh perspectives and up-to-date insights from the world’s leading authorities on the pathophysiology, diagnosis, and management of stroke. [books.google.de]

NPH and BD share the major part of symptoms and MRI changes, indicating a common pathophysiological pattern, and we raise the question of how to treat BD patients. [ncbi.nlm.nih.gov]

The detailed section on pathophysiology will enhance clinicians' understanding of this complex disorder. Finally there is a section on pharmacological and neuropsychological treatment of cognitive and psychiatric symptoms. [books.google.es]

It examines the differential neuropathological and pathophysiological bases of these dementias and emphasizes their behavioral and cognitive aspects in assessment, diagnosis, and treatment. [books.google.ro]

[…] of Binswanger's Disease The binswanger's disease is not curable but we can prevent it by preventing following methods Eating a healthy diet. [depression-guide.com]

Stay up to date on hot topics such as mechanisms of action of commonly used drugs, neuronal angiogenesis and stem cells, basic mechanisms of spasm and hemorrhage, prevention of stroke, genetics/predisposing risk factors, and much more. [books.google.de]

Nonetheless, diagnosis provides important knowledge and the opportunity to prevent further damage. Prevention typically involves bringing high blood pressure under control through exercise, diet, and medication. [webmd.com]

Because there is no cure, the best treatment is preventive, early in the adult years, by controlling risk factors such as hypertension, diabetes, and smoking. [ninds.nih.gov]

1. Huisa BN, Rosenberg GA. Binswanger’s disease: Diagnosis and Management. Expert Rev Neurother. 2014;14(10):1203-1213.
2. Huisa BN, Caprihan A, Thompson J, et al. Long-Term Blood-Brain Barrier Permeability Changes in Binswanger’s Disease. Stroke; a journal of cerebral circulation. 2015;46(9):2413-2418.
3. Kovács T, Szirmai I, Papp M. Clinico-pathology and differential diagnosis of Binswanger's disease [Article in Hungarian]. Ideggyogy Sz. 2005;58(3-4):78-87.
4. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
5. Akiguchi I, Budka H, Shirakashi Y, et al. MRI features of Binswanger’s disease predict prognosis and associated pathology. Annals of Clinical and Translational Neurology. 2014;1(10):813-821.
6. Bennett DA, Wilson RS, Gilley DW, Fox JH. Clinical diagnosis of Binswanger's disease. J Neurol Neurosurg Psychiatry. 1990;53:961-965.
7. Moretti R, Torre P, Antonello RM, Manganaro D, Vilotti C, Pizzolato G. Risk factors for vascular dementia: Hypotension as a key point. Vasc Health Risk Manag. 2008;4(2):395-402.