What Is Binswanger's Disease?
Binswanger's disease, also known as subcortical vascular dementia, is a kind of dementia caused by widespread, tiny regions of white matter damage in the brain's deep layers. The damage is caused by the thickening and constriction (atherosclerosis) of the arteries that supply the subcortical region of the brain. Atherosclerosis (also known as "artery stiffening") is a systemic disease that affects blood vessels all over the body.
The build-up of lipids, cholesterol, and other elements in and on the walls of your arteries is known as atherosclerosis. Plaque is the term used for this accumulation of fat and lipids. The arteries may narrow as a result of the plaque, thereby interfering with the blood flow. A blood clot can happen if the plaque bursts. It starts late in life, in the fourth decade, and gets worse as you get older. The blood supply to the brain tissue reduces as the arteries narrow, and this ultimately leads to the death of brain tissue.
What Is the Cause of Binswanger's Disease?
Binswanger's disease is a condition that affects people suffering from thromboembolism, where a blood clot that forms in an artery breaks away, travels through the bloodstream and stops another blood vessel; arteriosclerosis is a condition in which thickening, stiffening, and loss of flexibility of artery walls occur and other diseases that impede blood flow to the brain's deep areas. Binswanger disease is caused by hypertension, smoking, hypercholesterolemia, cardiac disease, and diabetes mellitus.
Binswanger's illness can also be caused by rare genetic diseases like CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy). CADASIL is a rare genetic condition that affects the small blood vessels present in the brain. CADASIL is a word that was originally coined in 1993. Even among members of the same family, the age of onset, intensity, particular symptoms, and illness course differ significantly.
CADASIL is an acronym that stands for the following words: (C) cerebral - having to do with the brain, (A) autosomal, (D) dominant– a type of inheritance in which only one copy of a defective gene is required for the disorder to manifest, (A) arteriopathy is an artery disease (blood vessels which carry blood away from the heart), specific parts of the brain nourished by deep tiny blood veins are referred to be (S) subcortical, (I) infarcts - brain tissue loss caused by a lack of blood flow to the brain, which happens when circulation through the tiny arteries is substantially diminished or interrupted, (L) leukoencephalopathy, which are lesions present in the white matter of the brain denoting the presence of the disease and gets reflected in a magnetic resonance imaging (MRI).
Binswanger disease, then, is a clinical syndrome of vascular dementia caused by a variety of factors rather than a single disease. Reduced blood flow in the brain tissue appears to cause secondary inflammation, which could be a target for therapy.
What Are the Symptoms and Signs of Binswanger's Disease?
Patients with Binswanger's disease frequently suffer from varying levels of cognitive impairment. People who have been affected are frequently unhappy, indifferent (uncaring), lazy, and incapable of acting or making decisions (abulic). They withdraw, make poor decisions, lack planning and organizational abilities, and communicate less naturally. Upper motor symptoms, asymmetric hyperreflexia, and moderate parkinsonism are common on physical examination. Dysarthria (difficulty speaking), dysphagia (difficulty swallowing), and urinary bladder control may also be problems for those who are affected (incontinence).
Some patients have symptoms comparable to Parkinson's disease, such as inadequate balance, slowness, and shuffling short steps (parkinsonism). Tremor is a rather uncommon symptom. Many persons with Binswanger disorder have previously experienced transient ischemic attacks or strokes. The signs and symptoms of this ailment, in contrast to being steadily progressive like the course of other neurodegenerative disorders, emerge in a stepwise or a stuttering pattern.
How Is Binswanger's Disease Diagnosed?
The diagnosis of Binswanger's disease can be difficult at first, but as the clinical course is learned, the diagnosis becomes more apparent. White matter hyperintensities, for example, are discovered by chance while examining the brains of healthy people. These individuals are self-sufficient, and no impairments may be detected during an office visit. Similar population studies with in-depth neuropsychological evaluations, on the other hand, have found a link between white matter hyperintensities and mild cognitive impairment. In population-level investigations, white matter hyperintensities were also linked to an increased risk of intracerebral hemorrhage and ischemic stroke. White matter hyperintensities in the subclinical stage linked to hypertension could be a precursor to Binswanger's disease.
A comprehensive clinical evaluation that includes a full medical history of the patient, physical examination, and computerized tomography (CT) or magnetic resonance imaging (MRI) scans of the brain is commonly used to diagnose Binswanger's illness. In the deep structures of the brain, magnetic resonance imaging (MRI) and computerized tomography (CT) scans demonstrate nerve fiber (white matter) deterioration and many minor strokes.
What Is the Treatment for Binswanger's Disease?
Considering that Binswanger disease's ischemic brain damage is permanent, treatment focuses on reducing factors that can cause stroke and, therefore, slowing the disease's progression. Symptomatic treatment is used. Antidepressant drugs such as Sertraline or Citalopram, which are serotonin-specific reuptake inhibitors (SSRIs), may be necessary for people suffering from depression or anxiety. Atypical antipsychotic drugs like Olanzapine and Risperidone can help persons with hyperactivity and disruptive behavior. Treatments include blood pressure medications, antiplatelet medicines including Warfarin or Aspirin to avoid thromboembolism, Statins to avoid atherosclerosis, cessation of smoking, and diabetes management. For treating depression generated due to Binswanger disease, antidepressant drugs are helpful. The only other option is symptomatic and supportive treatment.
Dr. Binswanger: Who Was He?
Dr. Otto Binswanger was born in Switzerland on October 14, 1852, and died on July 15, 1929. Binswanger went on to become a doctor and spent several years as the director of a mental institution. He described a disorder he dubbed "encephalitis subcorticalis chronica progressiva" in 1894, which became known as Binswanger's disease later.
Conclusion:
Binswanger's disease is a chronic illness, and changes can be immediate or gradual, usually progressing in stages. Binswanger's disease and Alzheimer's disease frequently coexist. This disease can be slowed by behaviors that delay the onset of high blood pressure, diabetes, and atherosclerosis, such as eating a balanced diet and following a healthy wake or sleep schedule, regular exercising, and not smoking or drinking alcohol.
