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What is Binswanger's Disease?
Binswanger's disease (BD), also called subcortical vascular dementia, is a type of dementia caused by widespread, microscopic areas of damage to the deep layers of white matter in the brain. The damage is the result of the thickening and narrowing (atherosclerosis) of arteries that feed the subcortical areas of the brain. Atherosclerosis (commonly known as "hardening of the arteries") is a systemic process that affects blood vessels throughout the body. It begins late in the fourth decade of life and increases in severity with age. As the arteries become more and more narrowed, the blood supplied by those arteries decreases and brain tissue dies. A characteristic pattern of Binswanger's disease-damaged brain tissue can be seen with modern brain imaging techniques such as CT scans or magnetic resonance imaging (MRI).
What are the symptoms of Binswanger's disease?
The symptoms associated with Binswanger's disease are related to the disruption of subcortical neural circuits that control what neuroscientists call executive cognitive functioning:
- short-term memory,
- the regulation of attention,
- the ability to act or make decisions, and
- appropriate behavior.
The most characteristic feature of Binswanger's disease is psychomotor slowness - an increase in the length of time it takes, for example, for the fingers to turn the thought of a letter into the shape of a letter on a piece of paper.
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 depression), and
- urinary symptoms that aren't caused by urological disease.
How is Binswanger's disease diagnosed?
Brain imaging, which reveals the characteristic brain lesions of Binswanger's disease, is essential for a positive diagnosis.
Is there any treatment for Binswanger's disease?
There is no specific course of treatment for Binswanger's disease. Treatment is symptomatic.
- People with depression or
anxiety may require antidepressant medications such as the serotonin-specific reuptake inhibitors (SSRI)
- Atypical antipsychotic drugs, such as
olanzapine, can be useful in individuals with agitation and disruptive behavior.
- Recent drug trials with the drug
memantine have shown improved cognition and stabilization of global functioning and behavior.
- The successful management of
diabetes can slow the progression of atherosclerosis, and subsequently slow the progress of
- 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.
IMAGESSee brain scan pictures of Alzheimer's and types of dementia See Images
What is the prognosis for Binswanger's disease?
Binswanger's disease is a progressive disease; there is no cure. Changes may be sudden or gradual and then progress in a stepwise manner. Binswanger's disease can often coexist with Alzheimer's disease. Behaviors that slow the progression of high blood pressure, diabetes, and atherosclerosis -- such as eating a healthy diet and keeping healthy wake/sleep schedules, exercising, and not smoking or drinking too much alcohol -- can also slow the progression of Binswanger's disease.
What research is being done on Binswanger's disease?
The National Institute of Neurological Disorders and Stroke (NINDS) conducts research related to Binswanger's disease in its laboratories at the National Institutes of Health (NIH), and also supports additional research through grants to major medical institutions across the country. Much of this research focuses on finding better ways to prevent, treat, and ultimately cure neurological disorders, such as Binswanger's disease.
Source: National Institute of Neurological Disorders and Stroke (www.ninds.nih.gov)
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AnxietyAnxiety is a feeling of apprehension and fear characterized by symptoms such as trouble concentrating, headaches, sleep problems, and irritability. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. Treatment for anxiety may incorporate medications and psychotherapy.
Brain Layers PictureThat part of the central nervous system that is located within the cranium (skull). See a picture of Brain Layers and learn more about the health topic.
CT Scan (Computerized Tomography)A CT scan is an X-ray procedure that combines many X-ray images with the aid of a computer to generate cross-sectional and three-dimensional images of internal organs and structures of the body. A CT scan is a low-risk procedure. Contrast material may be injected into a vein or the spinal fluid to enhance the scan.
DementiaDementia is defined as a significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning. There are several different types of dementia, including cortical, subcortical, progressive, primary, and secondary dementias. Other conditions and medication reactions can also cause dementia. Dementia is diagnosed based on a certain set of criteria. Treatment for dementia is generally focused on the symptoms of the disease.
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Diabetes (Type 1 and Type 2)Diabetes is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Diabetes Treatment: Medication, Diet, and Insulin
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Type 1 diabetes is treated with:
- and a diabetic diet.
Type 2 diabetes is first treated with:
- weight reduction,
- a diabetic diet,
- and exercise.
When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
Heart disease (coronary artery disease) occurs when plaque builds up in the coronary arteries, the vessels that supply blood to the heart. Heart disease can lead to heart attack. Risk factors for heart disease include:
- High blood pressure
- High cholesterol
- Family history
Angina, shortness of breath, and sweating are just a few symptoms that may indicate a heart attack. Treatment of heart disease involves control of heart disease risk factors through lifestyle changes, medications, and/or stenting or bypass surgery. Heart disease can be prevented by controlling heart disease risk factors.
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MRI (Magnetic Resonance Imaging Scan)MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.
Smoking (How to Quit Smoking)Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.