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Nonspecific leukoencephalopathy associated with aging.
Neuroimaging Clin N Am. 1995 Feb; 5(1):33-44.NC

Abstract

With advancing age, the periventricular and subcortical white matter becomes susceptible to a heterogeneous assortment of tissue alterations that cannot be easily categorized in terms of traditionally defined neuropathologic disease. These alterations, which appear radiolucent on CT and hyperintense on T2-weighted MR imaging, are more common in patients with chronic hypertension and perhaps other microvascular arteriosclerotic risk factors. Examination of the affected tissue reveals a spectrum of histologic change that is graded with respect to pathologic severity. The majority of the alterations are of low histopathologic grade and exert minimal clinical effects. Frequently observed microscopic changes include dilated perivascular (Virchow-Robin) spaces, mild demyelination, gliosis, and diffuse regions neuropil vacuolation. Associated clinical abnormalities, when present, are usually confined to deficits of attention, mental processing speed, and psychomotor control. These deficits may often be demonstrable only through neuropsychologic testing. There is some evidence that the cognitive symptoms of AD may be exacerbated by the concomitant presence of these white matter alterations, but an etiologic link between AD and radiographically detectible white matter changes remains speculative. Occasionally, histologically severe white matter lesions may occur that result in dementia and focal neurologic impairment. These lesions are characterized by extensive arteriosclerosis, diffuse white matter necrosis, and lacunar infarction; affected patients may receive a diagnosis of Binswanger's disease or subcortical arteriosclerotic encephalopathy. Nevertheless, severe ischemic white matter pathology of this type is uncommon as an explanation for serious neurologic dysfunction, and clinicians must carefully weigh other categories of neuropathology before making a diagnosis of Binswanger's disease. Alternative diagnostic considerations include neurodegenerative illnesses such as AD, cerebral infarction, neoplasm, and other forms of white matter pathology such as those due to infection, inflammation, a primary demyelinative condition, or metabolic leukodystrophy.

Authors+Show Affiliations

Department of Psychiatry, New York University Medical Center, New York, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

7743083

Citation

Golomb, J, et al. "Nonspecific Leukoencephalopathy Associated With Aging." Neuroimaging Clinics of North America, vol. 5, no. 1, 1995, pp. 33-44.
Golomb J, Kluger A, Gianutsos J, et al. Nonspecific leukoencephalopathy associated with aging. Neuroimaging Clin N Am. 1995;5(1):33-44.
Golomb, J., Kluger, A., Gianutsos, J., Ferris, S. H., de Leon, M. J., & George, A. E. (1995). Nonspecific leukoencephalopathy associated with aging. Neuroimaging Clinics of North America, 5(1), 33-44.
Golomb J, et al. Nonspecific Leukoencephalopathy Associated With Aging. Neuroimaging Clin N Am. 1995;5(1):33-44. PubMed PMID: 7743083.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nonspecific leukoencephalopathy associated with aging. AU - Golomb,J, AU - Kluger,A, AU - Gianutsos,J, AU - Ferris,S H, AU - de Leon,M J, AU - George,A E, PY - 1995/2/1/pubmed PY - 1995/2/1/medline PY - 1995/2/1/entrez SP - 33 EP - 44 JF - Neuroimaging clinics of North America JO - Neuroimaging Clin N Am VL - 5 IS - 1 N2 - With advancing age, the periventricular and subcortical white matter becomes susceptible to a heterogeneous assortment of tissue alterations that cannot be easily categorized in terms of traditionally defined neuropathologic disease. These alterations, which appear radiolucent on CT and hyperintense on T2-weighted MR imaging, are more common in patients with chronic hypertension and perhaps other microvascular arteriosclerotic risk factors. Examination of the affected tissue reveals a spectrum of histologic change that is graded with respect to pathologic severity. The majority of the alterations are of low histopathologic grade and exert minimal clinical effects. Frequently observed microscopic changes include dilated perivascular (Virchow-Robin) spaces, mild demyelination, gliosis, and diffuse regions neuropil vacuolation. Associated clinical abnormalities, when present, are usually confined to deficits of attention, mental processing speed, and psychomotor control. These deficits may often be demonstrable only through neuropsychologic testing. There is some evidence that the cognitive symptoms of AD may be exacerbated by the concomitant presence of these white matter alterations, but an etiologic link between AD and radiographically detectible white matter changes remains speculative. Occasionally, histologically severe white matter lesions may occur that result in dementia and focal neurologic impairment. These lesions are characterized by extensive arteriosclerosis, diffuse white matter necrosis, and lacunar infarction; affected patients may receive a diagnosis of Binswanger's disease or subcortical arteriosclerotic encephalopathy. Nevertheless, severe ischemic white matter pathology of this type is uncommon as an explanation for serious neurologic dysfunction, and clinicians must carefully weigh other categories of neuropathology before making a diagnosis of Binswanger's disease. Alternative diagnostic considerations include neurodegenerative illnesses such as AD, cerebral infarction, neoplasm, and other forms of white matter pathology such as those due to infection, inflammation, a primary demyelinative condition, or metabolic leukodystrophy. SN - 1052-5149 UR - https://www.unboundmedicine.com/medline/citation/7743083/Nonspecific_leukoencephalopathy_associated_with_aging_ L2 - https://medlineplus.gov/braindiseases.html DB - PRIME DP - Unbound Medicine ER -