Binswanger's disease

Binwanger's disease is a form of vascular dementia caused by very severe high blood pressure.  Severe high blood pressure causes wear and tear injury on the small arteries in the brain over the course of many years.  This causes the walls of the arteries to become thickened and scarred and makes it difficult for the brain to precisely regulate blood flow.  This can cause white matter scarring which can be seen on the FLAIR-sequence on MRI (inset in the picture to the right) and microhemorrhages in a distinctive pattern (preferentially, but not exclusively, involving the basal ganglia, pons and cerebellum).  The dementia associated with Binswanger's disease is distinctive because it causes slow processing speed. 

The key to treating Binswanger's disease is to control the blood pressure.  Patients and their families are asked to monitor blood pressure at home at least daily and work with hypertension-specialists to achieve pristine blood pressure control.  Controlling diabetes, quitting smoking and lowering cholesterol are also very important.  Unlike many other causes of dementia, we believe that the progression of Binswanger's disease can, in many cases,  be slowed or stopped if blood pressure and other vascular risk factors can be carefully optimized.  Because Binswanger's disease is closely linked to atherosclerosis, patients are often treated with aspirin to reduce the risk of strokes (although, as always, this decision needs to be made with your doctor to ensure the benefits outweigh the risks of hemorrhage in any particular case).  Mood symptoms, particularly depression, are also common in Binswanger's disease and this can be treated with a combination of medications, an active lifestyle and in some cases psychotherapy.