Journal List > Dement Neurocogn Disord > v.11(3) > 1120806

Dement Neurocogn Disord. 2012 Sep;11(3):79-86. Korean.
Published online Sep 30, 2012.  https://doi.org/10.12779/dnd.2012.11.3.79
Copyright© 2012 Korean Dementia Association
Micro-vascular Diseases of White Matter
Woojun Kim, M.D. and Dong Won Yang, M.D.
Department of Neurology, The Catholic University of Korea, College of Medicine, Seoul, Korea.

Address for correspondence: Dong Won Yang, M.D. Department of Neurology, The Catholic University of Korea, College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea. Tel: +82-2-2258-6077, Fax: +82-2-599-9686, Email: neuroman@catholic.ac.kr
Received Sep 21, 2012; Revised Sep 25, 2012; Accepted Sep 25, 2012.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.

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

Figures


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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Tables


Table 1
The rating scale for white matter changes on MRI by Erkinjuntti et al. [8]
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Table 2
The rating scale for white matter changes on MRI by Fazekas et al. [8]
Click for larger image

References
1. de Leeuw FE, de Groot JC, Achten E, Oudkerk M, Ramos LM, Heijboer R, et al. Prevalence of cerebral white matter lesions in elderly people: a population based magnetic resonance imaging study. The Rotterdam Scan Study. J Neurol Neurosurg Psychiatry 2001;70:9–14.
2. Jeerakathil T, Wolf PA, Beiser A, Massaro J, Seshadri S, D'Agostino RB, et al. Stroke risk profile predicts white matter hyperintensity volume: the Framingham Study. Stroke 2004;35:1857–1861.
3. Schmahmann JD, Smith EE, Eichler FS, Filley CM. Cerebral white matter: neuroanatomy, clinical neurology, and neurobehavioral correlates. Ann N Y Acad Sci 2008;1142:266–309.
4. Schmidt R, Fazekas F, Kapeller P, Schmidt H, Hartung HP. MRI white matter hyperintensities: three-year follow-up of the Austrian Stroke Prevention Study. Neurology 1999;53:132–139.
5. Fernando MS, Simpson JE, Matthews F, Brayne C, Lewis CE, Barber R, et al. MRC Cognitive Function and Ageing Neuropathology Study Group. White matter lesions in an unselected cohort of the elderly: molecular pathology suggests origin from chronic hypoperfusion injury. Stroke 2006;37:1391–1398.
6. Roman GC. Brain hypoperfusion: a critical factor in vascular dementia. Neurol Res 2004;26:454–458.
7. Kapeller P, Barber R, Vermeulen RJ, Ader H, Scheltens P, Freidl W, et al. Visual rating of age-related white matter changes on magnetic resonance imaging: scale comparison, interrater agreement, and correlations with quantitative measurements. Stroke 2003;34:441–445.
8. Erkinjuntti T. Subcortical ischemic vascular disease and dementia. Int Psychogeriatr 2003;15 Suppl 1:23–26.
9. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. AJR Am J Roentgenol 1987;149:351–356.
10. Scheltens P, Barkhof F, Leys D, Pruvo JP, Nauta JJ, Vermersch P, et al. A semiquantative rating scale for the assessment of signal hyperintensities on magnetic resonance imaging. J Neurol Sci 1993;114:7–12.
11. Pantoni L, Poggesi A, Inzitari D. Cognitive decline and dementia related to cerebrovascular diseases: some evidence and concepts. Cerebrovasc Dis 2009;27 Suppl 1:191–196.
12. Prasad K, Wiryasaputra L, Ng A, Kandiah N. White matter disease independently predicts progression from mild cognitive impairment to Alzheimer's disease in a clinic cohort. Dement Geriatr Cogn Disord 2011;31(6):431–434.
13. Longstreth WT Jr, Arnold AM, Beauchamp NJ Jr, Manolio TA, Lefkowitz D, Jungreis C, et al. Incidence, manifestations, and predictors of worsening white matter on serial cranial magnetic resonance imaging in the elderly: the Cardiovascular Health Study. Stroke 2005;36:56–61.
14. van den Heuvel DM, ten Dam VH, de Craen AJ, Admiraal-Behloul F, Olofsen H, Bollen EL, et al. Increase in periventricular white matter hyperintensities parallels decline in mental processing speed in a non-demented elderly population. J Neurol Neurosurg Psychiatry 2006;77:149–153.
15. Richard E, Gouw AA, Scheltens P, van Gool WA. Vascular care in patients with Alzheimer disease with cerebrovascular lesions slows progression of white matter lesions on MRI: the evaluation of vascular care in Alzheimer's disease (EVA) study. Stroke 2010;41:554–556.
16. Jellinger KA. Alzheimer disease and cerebrovascular pathology: an update. J Neural Transm 2002;109:813–836.
17. Jellinger KA. Morphologic diagnosis of "vascular dementia" - a critical update. J Neurol Sci 2008;270:1–12.
18. De Groot JC, De Leeuw FE, Oudkerk M, Van Gijn J, Hofman A, Jolles J, et al. Periventricular cerebral white matter lesions predict rate of cognitive decline. Ann Neurol 2002;52:335–341.
19. van den Heuvel DM, ten Dam VH, de Craen AJ, Admiraal-Behloul F, Olofsen H, Bollen EL, et al. Increase in periventricular white matter hyperintensities parallels decline in mental processing speed in a non-demented elderly population. J Neurol Neurosurg Psychiatry 2006;77:149–153.
20. Park KH, Lee JY, Na DL, Kim SY, Cheong HK, Moon SY, et al. Different associations of periventricular and deep white matter lesions with cognition, neuropsychiatric symptoms, and daily activities in dementia. J Geriatr Psychiatry Neurol 2011;24:84–90.
21. Herrmann LL, Le Masurier M, Ebmeier KP. White matter hyperintensities in late life depression: a systematic review. J Neurol Neurosurg Psychiatry 2008;79:619–624.
22. Seo SW, Lee JM, Im K, Park JS, Kim SH, Kim ST, et al. Cortical thinning related to periventricular and deep white matter hyperintensities. Neurobiol Aging 2012;33:1156–1167.
23. Wen W, Sachdev PS, Chen X, Anstey K. Gray matter reduction is correlated with white matter hyperintensity volume: a voxel-based morphometric study in a large epidemiological sample. Neuroimage 2006;29:1031–1039.
24. Selden NR, Gitelman DR, Salamon-Murayama N, Parrish TB, Mesulam MM. Trajectories of cholinergic pathways within the cerebral hemispheres of the human brain. Brain 1998;121(Pt 12):2249–2257.
25. Bocti C, Swartz RH, Gao FQ, Sahlas DJ, Behl P, Black SE. A new visual rating scale to assess strategic white matter hyperintensities within cholinergic pathways in dementia. Stroke 2005;36:2126–2131.
26. Reed BR, Eberling JL, Mungas D, Weiner M, Kramer JH, Jagust WJ. Effects of white matter lesions and lacunes on cortical function. Arch Neurol 2004;61:1545–1550.
27. Schmidt R, Fazekas F, Kapeller P, Schmidt H, Hartung HP. MRI white matter hyperintensities: three-year follow-up of the Austrian Stroke Prevention Study. Neurology 1999;53:132–139.
28. van der Flier WM, van Straaten EC, Barkhof F, Ferro JM, Pantoni L, Basile AM, et al. Medial temporal lobe atrophy and white matter hyper-intensities are associated with mild cognitive deficits in non-disabled elderly people: the LADIS study. J Neurol Neurosurg Psychiatry 2005;76:1497–1500.
29. Gold G, Kovari E, Herrmann FR, Canuto A, Hof PR, Michel JP, et al. Cognitive consequences of thalamic, basal ganglia, and deep white matter lacunes in brain aging and dementia. Stroke 2005;36:1184–1188.
30. van Den Boom R, Lesnik Oberstein SA, van Duinen SG, Bornebroek M, Ferrari MD, Haan J, et al. Subcortical lacunar lesions: an MR imaging finding in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Radiology 2002;224:791–796.
31. Viitanen M, Kalimo H. CADASIL: hereditary arteriopathy leading to multiple brain infarcts and dementia. Ann N Y Acad Sci 2000;903:273–284.
32. Smith EE, Greenberg SM. Beta-amyloid, blood vessels, and brain function. Stroke 2009;40:2601–2606.
33. Weller RO, Nicoll JA. Cerebral amyloid angiopathy: pathogenesis and effects on the ageing and Alzheimer brain. Neurol Res 2003;25:611–616.
34. McCarron MO, Nicoll JA. Apolipoprotein E genotype and cerebral amyloid angiopathy-related hemorrhage. Ann N Y Acad Sci 2000;903:176–179.
35. Chen YW, Gurol ME, Rosand J, Viswanathan A, Rakich SM, Groover TR, et al. Progression of white matter lesions and hemorrhages in cerebral amyloid angiopathy. Neurology 2006;67:83–87.