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Nonspecific leukoencephalopathy associated with aging

J Golomb1, A Kluger, J Gianutsos

  • 1Department of Psychiatry, New York University Medical Center, New York, USA.

Neuroimaging Clinics of North America
|February 1, 1995
PubMed
Summary
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Aging causes white matter alterations, often linked to hypertension. While minor changes affect cognition subtly, severe lesions may indicate Binswanger's disease, though other conditions are more common.

Area of Science:

  • Neuropathology
  • Vascular Neurology
  • Neuroimaging

Background:

  • Aging is associated with periventricular and subcortical white matter alterations.
  • These changes are often linked to chronic hypertension and microvascular arteriosclerosis.
  • Histologically, alterations range from mild demyelination and gliosis to severe necrosis and infarction.

Purpose of the Study:

  • To describe the spectrum of age-related white matter alterations.
  • To correlate histopathologic findings with clinical manifestations.
  • To differentiate these changes from other neuropathologies like Alzheimer's disease and Binswanger's disease.

Main Methods:

  • Review of neuropathologic findings in aging white matter.
  • Correlation with neuroimaging characteristics (CT, T2-weighted MRI).

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  • Clinical and neuropsychological assessment of affected individuals.

    • Main Results:

    • Low-grade alterations (dilated perivascular spaces, mild demyelination, gliosis) are common and associated with subtle cognitive deficits.
    • Severe lesions (arteriosclerosis, necrosis, lacunar infarction) can cause dementia and focal deficits, but are less common.
    • An etiological link between white matter changes and Alzheimer's disease remains speculative.

    Conclusions:

    • Age-related white matter changes are heterogeneous and often subclinical.
    • Severe white matter pathology is uncommon, and Binswanger's disease should be diagnosed cautiously.
    • Differential diagnosis requires consideration of neurodegenerative diseases, infarction, neoplasms, and other white matter pathologies.