The microvascular frontal-subcortical syndrome of aging

Many features of aging suggest dysfunction in both frontal and subcortical regions. Connections between the two areas form a series of pathways that critically influence various aspects of cognition, motor control, affect, and as recently discovered, normal urinary function. Age-related changes in the structure and integrity of these circuits may be associated with cognitive impairment, mood disorders, loss of balance, falls, and urinary dysfunction. In addition, cardiovascular risk factors in elderly people are associated with the development of cerebral microangiopathic changes in both the periventricular white matter and basal ganglia. These lesions are common, usually unsuspected, and were previously believed to be clinically innocuous. However, increasing evidence supports a role for these lesions as a cause for both dysfunction in frontal-subcortical systems, and many clinical features of aging that account for substantial disability. Because this form of cerebrovascular disease is potentially preventable, interventions that address risk factors for the development of cerebral microangiopathy may go a long way in preventing disability for the next generation of elderly persons.