Discovery Opens Door for Possible Treatment of a
Damage to white matter in brain may be due to many
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.
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
"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
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
"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
"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
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
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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