Dement Neurocogn Disord.  2012 Sep;11(3):79-86. 10.12779/dnd.2012.11.3.79.

Micro-vascular Diseases of White Matter

• Kim W
• Yang DW

• KMID: 2222351
• DOI: http://doi.org/10.12779/dnd.2012.11.3.79

Abstract

White matter hyperintensity (WMH) is commonly observed on the brain MRI of elderly subjects. It has been considered as an important biomarker for the micro-vascular damages of white matter of the brain. Aging, hypertension, diabetes mellitus, and hyperhomocysteinemia have been associated with WMH development. WMH is an important risk factor for the vascular dementia (VD), however it also considered as one of risk factors for conversion of mild cognitive impairment to dementia and progression of Alzheimer's disease (AD). WMH has impact on gait, bladder control, and fine motor coordination. It also has negative effects on memory retrieval, mental flexibility, mental processing speed, and executive function by disconnecting nerve fibers that convey signals for normal cognition. Control of vascular risk factors can delay progression of WMH and this may be beneficial for VD as well as AD with ischemic changes, especially in the early state of diseases. In this paper, we will review clinical significance of WMH and three important diseases, subcortical vascular dementia, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, and cerebral amyloid angiopathy that associated with cerebral micro-vascular damages.

Keyword

White matter hyperintensity; Vascular dementia; Micro-vascular damage; Alzheimer's disease

MeSH Terms

Aged
Aging
Alzheimer Disease
Brain
CADASIL
Cerebral Amyloid Angiopathy
Cognition
Dementia
Dementia, Vascular
Diabetes Mellitus
Executive Function
Gait
Humans
Hyperhomocysteinemia
Hypertension
Memory
Mild Cognitive Impairment
Nerve Fibers
Pliability
Risk Factors
Urinary Bladder
Cerebral Amyloid Angiopathy

Figure

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  Fig. 1 (A) Blood supply of cerebral white matter (WM) by (a) medullary artery (b) lenticulostriate artery and (c) choroidal artery. Dark circle represents a pneumbra zone of three arteries. (B) Area (a) is the most frequently affected WM regions of the subcortical vascular dementia patients.

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  Fig. 2 Microvascular changes of the brain in patients with subcortical vascular ischemic dementia. Toruous and elongated (A) and stenotic (B) changes of arterioles cause complete or incomplete infarcts in the white matter with two different mechanisms of ischemia.

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  Fig. 3 Visual rating scale of the white matter hyperintensities (WMH). Severity of WMH can be measured in the (a) periventricular area around the fontal and occipital horns of lateral ventricle (b) periventicular area long the lateral ventricle (c) deep white matter area.

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  Fig. 4 MRI and histopathologic features of the 72-year-old female with dementia and recurrent lobar hemorrhages. FLAIR axial MRI shows periventricular white matter hyperintensity and cortical lobar hemorrhage in the right frontal area (A). On gradient echo MRI, there are numerous microbleedings mostly on the cortex (B). Thickened homogeneous pink material is noted in the H&E stain (C). Apple-green birefringence of amyloid deposits is proved under the polarized light on Congo red stain (D).

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