Binswanger's disease: symptoms and treatment of this dementia

Dementias involve the loss of brain function, and are due to multiple causes and diseases. They affect memory, thought, language, judgment and behavior, and appear especially from the age of 60.

In this article we will talk about Binswanger's disease, a neurological disorder that causes vascular dementia. This type of dementia involves symptoms such as manic episodes and loss of inhibition, and constitutes 1-5% of all dementias.

• Related article: "Types of dementias: the 8 forms of loss of cognition"

Binswanger's disease: characteristics

Binswanger's disease is a disease that causes vascular-type dementia, and that characterized by atrophy of the cerebral white matter. It arises as a consequence of a vascular deficiency due to the existence of severe arteriosclerosis of the vessels supplying the deep white mass. Later we will see what is arteriosclerosis.

This type of dementia implies the presence of two types of infarcts: lacunar and cortical. At the prevalence level, dementia due to Binswanger's disease accounts for between 1 and 5% of all dementias.

• You may be interested: "Types of stroke (definition, symptoms, causes and severity)"

Risk factor's

The main risk factor for Binswanger's disease is high blood pressure (94% of patients with the disease are hypertensive), linked to age and the degree of severity of cerebral arteriosclerosis.

In addition, dementia is often associated with the presence of type 2 diabetes, thrombocytosis, hyperlipidemia, and coronary heart disease.

Symptoms

Patients with dementia due to Binswanger's disease, in most cases, have their first symptoms between the ages of 60 and 70. There are no differences between women and men in terms of symptoms or probabilities of developing this disease.

On the other hand, on average, the life expectancy of patients is 5 more years from the moment of diagnosis.

The first three symptoms of Binswanger's disease, which appear in the initial stages and in 70% of cases, are as follows.

1. Manic episodes

Manic episodes are defined and persistent periods during which the an abnormally high, expansive, or irritable mood. They are episodes easy to detect because the person feels especially energetic, impulsive and euphoric, with ideas of greatness. It is a psychological state similar to hypomania.

2. Impaired judgment

Judgment capacity is the cognition with which thought works; Judging involves establishing relationships between two or more concepts. In everyday life, we use judgment or logic to understand things and analyze reality with common sense.

Patients with dementia due to Binswanger's disease have impaired judgment or logic, presenting difficulties in this type of reasoning or thinking.

3. Loss of inhibition

Inhibition or inhibitory control is the human's ability to inhibit or control impulsive responses (or automatic), and generate responses mediated by attention and reasoning. It is a cognitive ability that helps to anticipate, plan and set goals.

In Binswanger's disease, this ability is impaired, and the patient loses the ability to plan and organize his behavior. In the same way, he begins to develop behavior patterns characterized by impulsivity.

4. Other symptoms

Later, and as the disease progresses, abulia (lack of will or energy to do something or to move) appears in the patient, as well as orientation problems. The person begins to depend on others when performing activities of daily living (AVC).

On the other hand, it can sometimes appear a loss of short-term or long-term memory, a characteristic that typically appears in various types of dementia. Mental symptoms may also appear associated with other symptoms of neurological origin, such as lack of motor coordination (when walking) or the presence of seizures.

Causes

Binswanger disease dementia is caused by a vascular deficiency. This is due to the existence of severe arteriosclerosis of the vessels that irrigate the white matter deep.

Arteriosclerosis, meanwhile, is a condition where plaque builds up inside the arteriesPlaque being a sticky substance made up of fat, cholesterol, calcium and other substances found in the blood. Over time, this plaque hardens and narrows the arteries, limiting the flow of oxygen-rich blood.

Treatment

Once Binswanger's disease dementia is diagnosed, treatment is essentially symptomatic. On the other hand, arterial hypertension is treated, until it is established in figures within normality (below 140/90 mm / Hg), which allows to stabilize the symptoms.

Some authors suggest reducing the hematocrit when it is above 45%; hematocrit is directly related to fibrinogen levels and blood viscosity.

It is important to note that the treatment of Binswanger's disease should primarily focus on a preventive and control treatment for high blood pressure, since this is the main risk factor associated with the disease. In this way, preventing and controlling hypertension will help prevent the cerebral arteriosclerosis that causes dementia.

Bibliographic references:

• Caplan L.R. (nineteen ninety five). Binswanger's disease revisited. Neurology, 45; 626-633.
• Libon, D.; Price, C.; Davis Garrett, K.; Giovannetti, T. (2004). From Binswanger's Disease to Leukoaraiosis: What We Have Learned About Subcortical Vascular Dementia. The Clinical Neuropsychologist. 18(1): 83 - 100.
• Rodríguez, L. and Serra, Y. (2002). Clinical-imaging characterization of Binswanger's disease. Rev cubana med 41 (3), Havana City. International Center for Neurological Restoration
• Valencia C. (2002). Comparative analysis of leukoaraiosis in Alzheimer's disease, Binswanger's disease, and lacunar infarcts. Conventional and spectroscopic MRI study. Autonomous University of Barcelona. Department of Medicine