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Genetic and Rare Diseases Information Center (GARD)

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Binswanger's disease

Other Names for this Disease
  • Dementia multi-infarct
  • Multi-infarct dementia
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Your Question

What causes Binswanger's disease? How is it diagnosed? Who is most commonly affected? What are the signs and symptoms? How is it treated? What is the prognosis?

Our Answer

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What is Binswanger's disease?

Binswanger's disease, 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.[1] Most patients experience progressive memory loss and deterioration of intellectual abilities (dementia), urinary urgency or incontinence, and an abnormally slow, shuffling, unsteady pattern of walking, usually over a 5-10 year period.[2] While there is no cure, the progression of Binswanger's disease can be slowed with healthy lifestyle choices. Treatment is symptomatic and supportive.[1] 
Last updated: 11/9/2009

What are the signs and 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, organization, mood, 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.[1]

Due to their vascular etiology, the symptoms and physical findings associated with Binswanger's 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 vessels become increasingly obstructed.[2]
Last updated: 11/9/2009

What causes Binswanger's disease?

Binswanger's disease is 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. As the arteries become more and more narrowed, the blood supplied by those arteries decreases and brain tissue dies.[1]
Last updated: 11/9/2009

Is Binswanger's disease an inherited condition?

While Binswanger's disease does not appear to follow a specific pattern of inheritance, genetics may play a role in the development of atherosclerosis.
Last updated: 11/9/2009

Who is most commonly affected by Binswanger's disease?

The thickening and narrowing (atherosclerosis) of arteries that feed the subcortical areas of the brain typically begins late in the fourth decade of life and increases in severity with age.[1]
Last updated: 11/9/2009

How is Binswanger's disease diagnosed?

Individuals with Binswanger's disease exhibit a characteristic pattern of damaged brain tissue which can be seen with modern brain imaging techniques such as CT scans or magnetic resonance imaging (MRI). The presence of these characteristic brain lesions are essential for a positive diagnosis.[1]
Last updated: 11/9/2009

How is Binswanger's disease treated?

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) sertraline or citalopram. Atypical antipsychotic drugs, such as risperidone and 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 hypertension and diabetes can slow the progression of atherosclerosis, and subsequently slow the progress of Binswanger's disease. 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.[1]
Last updated: 11/9/2009

What is the prognosis for individuals with 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.[1]

Last updated: 11/9/2009