This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

A Vascular Form of Dementia in the Elderly

Gustavo C. Román, MD

JAMA. 1987;258(13):1782-1788.

Abstract
Computed tomography and magnetic resonance imaging in the elderly have demonstrated the common occurrence of deep white-matter lesions in the aging brain. These radiologic lesions (leukoaraiosis) may represent an early marker of dementia. At autopsy, an ischemic periventricular leukoencephalopathy (Binswanger's disease) has been found in most cases. The clinical spectrum of Binswanger's disease appears to range from asymptomatic radiologic lesions to dementia with focal deficits, frontal signs, pseudobulbar palsy, gait difficulties, and urinary incontinence. The name senile dementia of the Binswanger type (SDBT) is proposed for this poorly recognized, vascular form of subcortical dementia. The SDBT probably results from cortical disconnection most likely caused by hypoperfusion. In contrast, multi-infarct dementia is correlated with multiple large and small strokes that cause a loss of over 50 to 100 mL of brain volume. The periventricular white matter is a watershed area irrigated by long, penetrating medullary arteries. Risk factors for SDBT are small-artery diseases, such as hypertension and amyloid angiopathy, impaired autoregulation of cerebral blood flow in the elderly, and periventricular hypoperfusion due to cardiac failure, arrhythmias, and hypotension. The SDBT may be a potentially preventable and treatable form of dementia.

(JAMA 1987;258:1782-1788)

Author Affiliations
From the Department of Neurology, Texas Tech University Health Sciences Center School of Medicine, Lubbock.

Footnotes
Reprint requests to Department of Neurology, Room 4A124, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX 79430 (Dr Román).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Prevalence of Subcortical Vascular Lesions and Association With Executive Function in Mild Cognitive Impairment Subtypes
Bombois et al.
Stroke 2007;38:2595-2597.
ABSTRACT | FULL TEXT  

Extent and distribution of white matter hyperintensities in normal aging, MCI, and AD
Yoshita et al.
Neurology 2006;67:2192-2198.
ABSTRACT | FULL TEXT  

White Matter Changes Associated With Psychotic Symptoms in Alzheimer's Disease Patients
Lee et al.
J. Neuropsychiatry Clin. Neurosi. 2006;18:191-198.
ABSTRACT | FULL TEXT  

Systemic Blood Pressure Profile in Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy
Rufa et al.
Stroke 2005;36:2554-2558.
ABSTRACT | FULL TEXT  

Cerebral white matter blood flow is constant during human non-rapid eye movement sleep: a positron emission tomographic study
Hiroki et al.
J. Appl. Physiol. 2005;98:1846-1854.
ABSTRACT | FULL TEXT  

Anatomical Mapping of White Matter Hyperintensities (WMH): Exploring the Relationships Between Periventricular WMH, Deep WMH, and Total WMH Burden
DeCarli et al.
Stroke 2005;36:50-55.
ABSTRACT | FULL TEXT  

Age-Associated White Matter Lesions and Dementia: Are These Lesions Causal or Casual?
Roman
Arch Neurol 2004;61:1503-1504.
FULL TEXT  

Cerebral Blood Volume in T2-Weighted White Matter Hyperintensities Using Exogenous Contrast Based Perfusion MRI
Sachdev et al.
J. Neuropsychiatry Clin. Neurosi. 2004;16:83-92.
ABSTRACT | FULL TEXT  

Hypertension in Older Adults
Rigaud and Forette
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2001;56:217M-225.
ABSTRACT | FULL TEXT  

Hippocampal and cortical atrophy predict dementia in subcortical ischemic vascular disease
Fein et al.
Neurology 2000;55:1626-1635.
ABSTRACT | FULL TEXT  

Orthostatic Hypotension as a Risk Factor for Stroke : The Atherosclerosis Risk in Communities (ARIC) Study, 1987-1996
Eigenbrodt et al.
Stroke 2000;31:2307-2313.
ABSTRACT | FULL TEXT  

Impact of White Matter Changes on Clinical Manifestation of Alzheimer's Disease : A Quantitative Study
Hirono et al.
Stroke 2000;31:2182-2188.
ABSTRACT | FULL TEXT  

Vascular Cell Components of the Medullary Arteries in Binswanger's Disease Brains : A Morphometric and Immunoelectron Microscopic Study
Lin et al.
Stroke 2000;31:1838-1842.
ABSTRACT | FULL TEXT  

Effect of the Apolipoprotein E {epsilon}4 Allele on White Matter Hyperintensities in Dementia
Hirono et al.
Stroke 2000;31:1263-1268.
ABSTRACT | FULL TEXT  

New Insight Into Binswanger Disease
Roman
Arch Neurol 1999;56:1061-1062.
FULL TEXT  

Coagulation Activation in Patients With Binswanger Disease
Tomimoto et al.
Arch Neurol 1999;56:1104-1108.
ABSTRACT | FULL TEXT  

Occurrence and Progression of Dementia in a Community Population Aged 75 Years and Older: Relationship of Antihypertensive Medication Use
Guo et al.
Arch Neurol 1999;56:991-996.
ABSTRACT | FULL TEXT  

Psychiatric and behavioral aspects of dementia of the Binswanger type
Nagaratnam and Nagaratnam
AM J ALZHEIMERS DIS OTHER DEMEN 1998;13:173-178.
ABSTRACT  

Neuropathological assessment of the lesions of significance in vascular dementia
Esiri et al.
J. Neurol. Neurosurg. Psychiatry 1997;63:749-753.
ABSTRACT | FULL TEXT  

Brain Infarction and the Clinical Expression of Alzheimer Disease
Roman
JAMA 1997;278:113-114.
ABSTRACT  

Alterations in Glia and Axons in the Brains of Binswanger's Disease Patients
Akiguchi et al.
Stroke 1997;28:1423-1429.
ABSTRACT | FULL TEXT  

Status of Risk Factors for Dementia Associated With Stroke
Gorelick
Stroke 1997;28:459-463.
ABSTRACT | FULL TEXT  

From UBOs to Binswanger's Disease: Impact of Magnetic Resonance Imaging on Vascular Dementia Research
Roman
Stroke 1996;27:1269-1273.
FULL TEXT  

Diffuse Vacuolization (Spongiosis) and Arteriolosclerosis in the Frontal White Matter Occurs in Vascular Dementia
Erkinjuntti et al.
Arch Neurol 1996;53:325-332.
ABSTRACT  

Low blood pressure and dementia in elderly people: the Kungsholmen project
Guo et al.
BMJ 1996;312:805-808.
ABSTRACT | FULL TEXT  

Fortnightly Review: Vascular dementia
Amar and Wilcock
BMJ 1996;312:227-231.
ABSTRACT | FULL TEXT  

The Significance of Cerebral White Matter Abnormalities 100 Years After Binswanger's Report : A Review
Pantoni and Garcia
Stroke 1995;26:1293-1301.
ABSTRACT | FULL TEXT  

Cardiovascular disease and distribution of cognitive function in elderly people: the Rotterdam study
Breteler et al.
BMJ 1994;308:1604-1608.
ABSTRACT | FULL TEXT  

Pathologic Correlates of Increased Signals of the Centrum Ovale on Magnetic Resonance Imaging
Munoz et al.
Arch Neurol 1993;50:492-497.
ABSTRACT  

Further Observations on the Pathology of Subcortical Lesions Identified on Magnetic Resonance Imaging
Chimowitz et al.
Arch Neurol 1992;49:747-752.
ABSTRACT  

Neuropsychological Correlates of White-Matter Lesions in Healthy Elderly Subjects: A Threshold Effect
Boone et al.
Arch Neurol 1992;49:549-554.
ABSTRACT  

Hypertension and the Brain
Phillips and Whisnant
Arch Intern Med 1992;152:938-945.
ABSTRACT  

Evaluation of Cerebral Biopsies for the Diagnosis of Dementia
Hulette et al.
Arch Neurol 1992;49:28-31.
ABSTRACT  

Binswanger's Disease and Normal-pressure Hydrocephalus: Clinical and Neuropsychological Comparison
Gallassi et al.
Arch Neurol 1991;48:1156-1159.
ABSTRACT  

Caudate Hyperintensities in Elderly Depressed Patients With Neuroleptic-Induced Parkinsonism
Figiel et al.
J Geriatr Psychiatry Neurol 1991;4:86-89.
ABSTRACT  

Subcortical Structural Changes in ECT-Induced Delirium
Figiel et al.
J Geriatr Psychiatry Neurol 1990;3:172-176.
ABSTRACT  

Cognition and White Matter Changes on Magnetic Resonance Imaging in Dementia
Kertesz et al.
Arch Neurol 1990;47:387-391.
ABSTRACT  

Binswanger's Disease: Some Neuropsychological Considerations
Libon et al.
J Geriatr Psychiatry Neurol 1990;3:31-40.
ABSTRACT  

White Matter Lesions on MRI in the Elderly: What Do They Mean?
J Geriatr Psychiatry Neurol 1990;3:55-56.
 

Brain White-Matter Changes in the Elderly Prone to Falling
Masdeu et al.
Arch Neurol 1989;46:1292-1296.
ABSTRACT  

Binswanger's Disease (Part II): Pathogenesis of Subcortical Arteriosclerotic Encephalopathy and Its Relation to Other Dementing Processes
Peterson and Summergrad
J Geriatr Psychiatry Neurol 1989;2:171-181.
ABSTRACT  

Binswanger's Disease (Part I): The Clinical Recognition of Subcortical Arteriosclerotic Encephalopathy in Elderly Neuropsychiatric Patients
Summergrad and Peterson
J Geriatr Psychiatry Neurol 1989;2:123-133.
ABSTRACT  

Ataxia, Chorea, Seizures, and Dementia: Pathologic Features of a Newly Defined Familial Disorder
Farmer et al.
Arch Neurol 1989;46:774-779.
ABSTRACT  

Selective Vulnerability of the Brain: New Insights into the Pathophysiology of Stroke
Collins et al.
ANN INTERN MED 1989;110:992-1000.
ABSTRACT  

Neuropsychological Test Findings in Subjects With Leukoaraiosis
Rao et al.
Arch Neurol 1989;46:40-44.
ABSTRACT