White matter: beyond focal disconnection

The complex phenomenology of white matter dementia and many neuropsychiatric disorders implies that they originate from involvement of distributed neural networks, and white matter neuropathology is increasingly implicated in the pathogenesis of these network disconnection syndromes. White matter disorders produce functional asynchrony of interdependent cerebral regions subserving normal cognitive and emotional functions. Accumulating evidence suggests that white matter dementia primarily reflects disturbed frontal systems connectivity, whereas disruption of frontal and temporal lobe systems is implicated in the pathogenesis of neuropsychiatric disorders. Continued study of normal and abnormal white matter promises to help resolve challenging problems in behavioral neurology and neuropsychiatry.