Dementia and brain atrophy in patients with cerebral infarction of the Binswanger type

Abstract

The clinical spectrum of cerebral infarction of the Binswanger type, accompanied by severe perventricular leukoencephalopathy ranges from ischemic stroke to dementia with focal deficits, pseudobulbar palsy, gait disturbance, urinary incontinence, and extrapyramidal signs. We examined the differences between the clinical and radiological features of patients with cerebral infarction of the Binswanger type with and without dementia.
Of the 33 patients studied (15 males and 17 females; mean age ± SD, 79.8 ± 5.8 [range 69-90] years), 11 were classified as non-demented and the other 21 as demented on the basis of the DSM-III-R criteria and neuropsychological testing. The periventricular hyperintensity (PVH), temporal horn and body of the lateral ventricle, brain parenchyma, subarachnoid space, and temporal lobe were measured planimetrically by MRI, and the white matter hyperintensity (WMH) and infarcts of the basal ganglia/thalamus were assessed on the basis of subjective ratings. There were no significant differences between the non-demented and demented patients in terms of age, sex, and cerebrovascular risk factors. Clinically, extrapyramidal signs were observed more often in demented than in non-demented patients, and the ADL (activities of daily living) showed significantly poorer values in demented patients. MRI studies revealed no significant differences between the non-demented and demented patients in terms of the ratios for the PVH, temporal lobe area and subarachnoid space, or in the degrees of WMH and infarcts in the subcortical gray matter. However, the ratios for the temporal horn and body areas of the lateral ventricle were significantly higher in demented than in non-demented patients, and the brain parenchyma ratio was significantly lower in demented patients. The temporal horn area ratio was significantly higher in mildly and severely demented patients than in non-demented patients and the brain parenchyma ratio was significantly lower in severely demented patients than in non-demented and mildly demented patients.
Thus clinical features such as subcortical cerebral dysfunction and the ADL, and brain atrophy differed between non-demented and demented patients with cerebral infarction of the Binswanger type. Moreover, our data suggest that medial temporal lobe atrophy appears in the early stages of dementia, while generalized atrophy of the cerebral parenchyma follows in the advanced stages.