Age-related cerebral white matter disease (leukoaraiosis): a review

Abstract

With the availability of improved brain imaging techniques, the high prevalence and clinical importance of cerebral small vessel disease have been increasingly recognised in recent years. As age is one of the most important risk factors for this condition, its prevalence is set to rise further as populations age. This may lead to an increase in the clinical consequences of white matter disease, namely cognitive decline, decreased mobility and increased stroke risk. Given the impact this will have on individuals and on healthcare systems, knowledge of the risk factors for small vessel disease, its prevention and its treatment is becoming more important. Although a lot of data are now available on the epidemiology, risk factors, clinical consequences and prognosis of leukoaraiosis, some of this information is conflicting. In this review, we summarise the current literature on cerebral small vessel disease, with an emphasis on its clinical aspects.

Reperfusion Injury on Magnetic Resonance Imaging After Carotid Revascularization

“…9 Age is the most important risk factor for leukoaraiosis. 10 Thus, it is plausible that age and leukoaraiosis, both of which are related to a vulnerable blood-brain barrier, might be predictors for HARM after revascularization. The relationship between postprocedural high blood pressure and the development of HARM in this study is in line with the previous notion that postoperative hypertension is a risk for cerebral hyperperfusion syndrome after CEA.…”

Leukoaraiosis on MRI in Patients with Minimally Symptomatic Obstructive Sleep Apnoea

“…Leukoaraiosis or ‘age-related white matter changes (ARWMC)' are commonly observed on CT or MRI brain examinations in the elderly [1]. These lesions are thought to be due to chronic ischaemia from damage to the small penetrating vessels, endothelial dysfunction, and disruption of the blood-brain barrier [1].…”

“…These lesions are thought to be due to chronic ischaemia from damage to the small penetrating vessels, endothelial dysfunction, and disruption of the blood-brain barrier [1]. Hypertension and increasing age are the best established risk factors [1,2,3].…”

Introductory Chapter: Microcirculation in Health and Disease

“…The term, potentially unfamiliar to broader medical public, denotes diffuse confluent changes in the cerebral white matter often accidentally detected on neuroradiological imaging. Its prevalence in the population aged between 50 and 75 years has been estimated to comprise up to 25% and, as such, undoubtedly must be regarded as highly clinical significant in terms of predisposing to various degrees of cognitive impairment, ischemic events, and stroke [32]. In his chapter, Zupan thoroughly describes the pathogenesis of leukoaraiosis, which includes a spectrum of factors, often apparently discordant, ranging from endothelial dysfunction to leaky bloodbrain barrier on one side [33], to ischemia on the other [34], yet all causing chronic perfusion impairment.…”