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Binswanger Disease

Binswanger disease, a type of vascular dementia, is characterized by atherosclerosis of blood vessels supplying the deep white matter of the brain. Hypertension, being the principal risk factor, is universally present, and a variable degree of cognitive impairment, gait disturbances and other neurological deficits are encountered in patients. A thorough physical examination and magnetic resonance imaging (MRI) of the brain are necessary to make the diagnosis.


Presentation

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]
  • Definition Binswanger disease is a rare form of progressive dementia that develops after age 60 and involves degeneration of the brain's white matter.[encyclopedia.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]
  • Types of Lewy body dementia include: Dementia with Lewy bodies (DLB), one of the more common forms of progressive dementia.[alzheimersweekly.com]
Loss of Attention
  • Symptoms of Binswanger disease include short-term memory loss, short attention span, inappropriate behaviors, inability to make decisions, change in mood and personality, an unsteady gait, clumsiness or frequent falls and a decrease in organizational[theadvocate.com]
Short Attention Span
  • Symptoms of Binswanger disease include short-term memory loss, short attention span, inappropriate behaviors, inability to make decisions, change in mood and personality, an unsteady gait, clumsiness or frequent falls and a decrease in organizational[theadvocate.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]
  • So, the stroke can be roughly divided into two categories, ischemic stroke and hemorrhagic stroke. 3.1 ischemic stroke ischemic stroke accounted for 60% -70% of the total number of patients with stroke, including cerebral thrombosis and cerebral embolism[e.uuuwell.com]
  • 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]
  • 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]
  • 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]
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]
  • 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]
  • 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]
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]
  • Seizures may also occur.[findmeacure.com]
  • Fully developed epileptic seizures can even occur during the disease.[www2.psykl.med.tum.de]
Agitation
  • 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]
  • Atypical antipsychotic drugs, such as risperidone and olanzapine, can be useful in individuals with agitation and disruptive behavior.[ninds.nih.gov]
  • Anti-psychotic drugs are often administered for individuals experiencing high agitation levels or disruptive behaviors. The drug memantine has been shown to stabilize functioning.[theadvocate.com]
  • The people with depression require antidepressant medication because it consist of serotonin-specific reuptake inhibitors (SSRI) sertraline The drugs antipsychotic like risperidone and olanzapine can be helpful with agitation and disruptive behavior.[depression-guide.com]
Irritability
  • 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]
  • 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]
  • 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,[braindiseases.blogspot.com]
  • Irritability. Clumsiness. Diagnosis: There are no specific laboratory markers for the disease.[medigoo.com]
Urinary Incontinence
  • Clinically, Lacunar Dementia presents with gait difficulties, urinary incontinence, parkinsonian features, pseudobulbar palsy, emotional incontinence and dementia.[ncbi.nlm.nih.gov]
  • […] 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]
  • Symptoms include depression, muscle rigidity, difficulties walking and urinary incontinence. There is no cure for the condition.[sciencephoto.com]

Workup

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].

Treatment

  • 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.ro]
  • 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

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

Etiology

  • The etiology is considered to be vascular and to represent a special course of arteriosclerosis.[ncbi.nlm.nih.gov]
  • Hypertension might be the sole etiologic factor, a necessary but not the only causative agent, or a contributing but non-requisite element. 60 patients with clinical and computed tomographic (CT) features of subcortical arteriosclerotic encephalopathy[medigoo.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]

Epidemiology

  • 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]
  • […] 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]
  • However, there are typical epidemiological and clinical features that may facilitate VCI diagnosis at its early stages prior to the development of dementia. These patients are typically hypertensive and have gait disturbances.[academic.oup.com]
  • 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]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • 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]
  • 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]
  • 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]

Prevention

  • […] 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]

References

Article

  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.

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Last updated: 2019-07-11 21:23