Dementias involves the loss of brain function, and is due to multiple causes and diseases. They affect memory, thinking, language, judgment and behavior, and appear mostly after age 60.
In this article we will talk about Binswanger’s disease, a neurological disorder that causes vascular dementia . This type of dementia involves symptoms such as manic episodes and the loss of inhibition, and constitutes 1-5% of all dementias.
Binswanger’s disease: characteristics
Binswanger’s disease is a disease that causes vascular-type dementia, and which is characterized by atrophy of the cerebral white matter . It arises as a consequence of a vascular deficiency due to the existence of severe arteriosclerosis of the vessels that supply the deep white mass. Later on we will see what atherosclerosis is.
This type of dementia involves the presence of infarctions of two types: lacunar and cortical. At the prevalence level, Binswanger’s disease dementia accounts for 1 to 5 percent of all dementias.
The main risk factor for Binswanger’s disease is high blood pressure (94% of patients with the disease are hypertensive), linked to the age and degree of severity of cerebral arteriosclerosis.
In addition, dementia is often also associated with the presence of type 2 diabetes, thrombocytosis, hyperlipidemia and coronary disease .
Patients with Binswanger’s disease dementia, in most cases, present their first symptoms between 60 and 70 years of age . There are no differences between women and men in terms of symptoms or likelihood of developing this disease.
On the other hand, on average, patients’ life expectancy is 5 years longer from the time of diagnosis.
The first three symptoms of Binswanger’s disease, which appear in the early stages and in 70% of cases, are
1. Manic episodes
Manic episodes are limited and persistent periods during which an abnormally high, expansive or irritable mood appears . They are easy to detect because the person feels particularly energetic, impulsive and euphoric, with ideas of grandiosity. This is a psychological state similar to hypomania.
2. Impaired judgment
The capacity of judgement is the cognition with which thought works ; judging means establishing relationships between two or more concepts. In everyday life, we use judgement or logic to understand things and analyse reality with common sense.
Patients with Binswanger’s disease dementia have impaired judgment or logic, presenting difficulties in this type of reasoning or thinking.
3. Loss of inhibition
Inhibition or inhibitory control is the ability of humans to inhibit or control impulsive (or automatic) responses , and to generate responses mediated by attention and reasoning. It is a cognitive skill that helps to anticipate, plan and set goals.
In Binswanger’s disease this ability is altered, and the patient loses that ability to plan and organize his or her behavior. Similarly, he begins to develop patterns of behavior characterized by impulsivity.
4. Other symptoms
Later, as the disease progresses, abulia (lack of will or energy to do something or to move) appears in the patient, as well as orientation problems. The person begins to depend on others when performing activities of daily living (CVA).
On the other hand, sometimes a loss of short-term or long-term memory can occur, a characteristic that typically appears in several types of dementia. Mental symptoms may also appear associated with other symptoms of neurological origin, such as a lack of motor coordination (when walking) or the presence of seizures.
Binswanger’s disease dementia is caused by a vascular deficiency. This is due to the existence of severe arteriosclerosis of the vessels that supply the deep white substance.
Atherosclerosis, on the other hand, is a condition where plaque builds up inside the arteries . Plaque is a sticky substance composed of fat, cholesterol, calcium, and other substances found in the blood. Over time, this plaque hardens and narrows the arteries, limiting the flow of oxygen-rich blood.
Once Binswanger’s disease dementia has been diagnosed, treatment is essentially symptomatic . On the other hand, high blood pressure is treated, until it is established in figures within normal range (below 140/90 mm/Hg), which allows the symptoms to be stabilised.
Some authors suggest reducing hematocrit when it is above 45%; hematocrit is directly related to fibrinogen levels and blood viscosity.
It is important to note that treatment of Binswanger’s disease should focus primarily on preventive and control treatment of high blood pressure , since this is the main risk factor associated with the disease. In this way, preventing and controlling hypertension will help to avoid the cerebral arteriosclerosis that causes dementia.
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