Open AccessMRI features of Binswanger's disease predict prognosis and associated pathology
Author(s) -
Akiguchi Ichiro,
Budka Herbert,
Shirakashi Yoshitomo,
Woehrer Adelheid,
Watanabe Toshiyuki,
Shiino Akihiko,
Yamamoto Yasumasa,
Kawamoto Yasuhiro,
Krampla Wolfgang,
Jungwirth Susanne,
Fischer Peter
Publication year - 2014
Publication title -
annals of clinical and translational neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.824
H-Index - 42
ISSN - 2328-9503
DOI - 10.1002/acn3.123
Subject(s) - medicine , magnetic resonance imaging , hyperintensity , cohort , white matter , pathological , nuclear medicine , radiology , pathology
Objective To identify the prevalence of MRI features of Binswanger's disease ( BD ), specifically MRI with diffuse white matter lesions and scattered multiple lacunes ( BD ‐ MRI ), and to describe neurological features and pathological outcomes of a community‐based cohort study. Methods Of 697 participants (all 75 years old), 503 completed neurological examinations at baseline and were followed‐up every 30 months thereafter with MRI s, the mini‐mental state examination ( MMSE ) and the Unified Parkinson Disease Rating Scale‐Motor Section ( UPDRSM ). Data from participants with BD ‐ MRI were compared with those from participants with predominant white matter lesions ( WML ‐ MRI ), scattered multiple lacunes ( ML ‐ MRI ), or normal MRI s. Results Fourteen BD ‐ MRI patients (2.8%) were detected at baseline. The mean MMSE scores in the BD ‐ MRI , WML ‐ MRI , ML ‐ MRI , and normal MRI s groups were 26.4, 28.2, 28.4, and 28.5, respectively, and the mean UPDRSM scores were 9.1, 1.3, 3.1, and 1.7, respectively. At the 30‐month follow‐up, mortality rates in the normal MRI s, WML ‐ MRI and ML ‐ MRI were 4%, 9.1%, and 22.2%, respectively, and follow‐up MRI s were available for 80%, 82%, and 61% of the participants, respectively. In the BD ‐ MRI , however, five patients were deceased, and only five follow‐up individual MRI s were available (33.3%). Autopsies were performed on six of eight BD ‐ MRI brains, and these brains fulfilled the pathological criteria for BD independent of Alzheimer disease pathology. All these six individuals also showed systemic atherosclerosis and renal arterio‐arteriolosclerosis. Interpretation The BD ‐ MRI participants had poor prognoses and showed pure BD pathology with advanced systemic vascular disease. BD ‐ MRI appears to be a predictor of vascular neurocognitive impairment.