Alzheimer's, Dementia & Mental Health

Discovery Opens Door for Possible Treatment of a Common Dementia

Damage to white matter in brain may be due to many unnoticed strokes

Doctor reviews brain scansOct. 30, 2014 - Brain scans find white matter damage in about half of all senior citizens, which is often harmless, but when the damage is severe, it can cause mental impairment. This has, however, been considered a natural part of aging. Now, researchers think this white matter disease (leukoaraiosis) may actually be the result of many tiny unnoticed strokes accumulating over time a finding they say points to a potentially treatable form of dementia.

Researchers at the Krembil Neuroscience Centre, Toronto, say that in this type of dementia, there is damage to the white matter (nerve fibers) of the brain apparent on computerized tomography (CT) and magnetic resonance imaging (MRI) scans of older individuals.  

Previous studies have already established that the more white matter disease there is in the brain, the more likely patients are to have symptoms of dementia such as cognitive impairment or changes in behavior. What was not understood is why this white matter disease develops the traditional assumption was that it might be the result of the natural aging process.

The research was published today in the journal Annals of Neurology.


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The researchers conducted an intensive study to observe the development of this white matter disease over a short period of time, rather than on an annual basis the interval at which previous studies have performed repeat brain imaging. The study involved 5 patients with white matter disease undergoing detailed MRI scanning of their brains every week for 16 consecutive weeks.

The weekly MRI scans revealed new tiny spots arising in the brain's white matter that were, based on their MRI appearance, characteristic of small new strokes (cerebral infarcts). The lesions had no symptoms but, with time, came to resemble the existing white matter disease in the subjects' brains. 

In the study's random sampling, the majority of subjects had this phenomenon: Tiny strokes occurring without symptoms, and developing into the kind of white matter disease that causes dementia

 "We were surprised by the study findings" said Dr. Daniel Mandell, Neuroradiologist, Joint Department of Medical Imaging, Toronto Western Hospital and the principal investigator of the study. "The findings suggest that the tiny, silent strokes are likely much more common than physicians previously appreciated, and these strokes are likely a cause of the age-related white matter disease that can lead to dementia."

Unlike degenerative types of dementia where there are no treatments, this type, based on vascular disease, is more treatable as it is caused by tiny episodes affecting the blood vessels in the brain over time. It may be possible to prevent or stop this process.

"We don't yet know whether these small strokes are responsible only some or most of the white matter disease seen in older patients," said Dr. Frank Silver, Neurologist and Medical Director, Stroke Program, Krembil Neuroscience Centre and a co-author of the study.

"But in those where it is the cause, the detection of white matter disease on brain imaging should trigger physicians to treat patients aggressively when managing stroke risk factors such as high blood pressure, diabetes, high cholesterol, cigarette smoking and lack of exercise not only to prevent further strokes, but also to reduce the development of cognitive impairment over time."

Although more research is needed to further investigate these findings with a larger sample size, if most white matter disease is found to be caused by these tiny strokes, it could eventually lead to interventions to delay its progression in the brain.

About Krembil Neuroscience Centre

The Krembil Neuroscience Centre (KNC), located at Toronto Western Hospital, reports to be the home to one of the largest combined clinical and research neurological facilities in North America. Since opening in 2001, KNC has been recognized as a world leader through its research achievements, education and exemplary patient care. The center focuses on the advancement, detection and treatment of neurological diseases and specializes in movement disorders, dementias, stroke, spinal cord injury, blinding eye diseases, epilepsy and cancer-related conditions.

About University Health Network
University Health Network consists of Toronto General and Toronto Western Hospitals, the Princess Margaret Cancer Centre, and Toronto Rehabilitation Institute. The UHN says the scope of research and complexity of cases at University Health Network has made it a national and international source for discovery, education and patient care. It reports the largest hospital-based research program in Canada, with major research in cardiology, transplantation, neurosciences, oncology, surgical innovation, infectious diseases, genomic medicine and rehabilitation medicine. University Health Network is a research hospital affiliated with the University of Toronto.

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