This article is about the most common aging brain problem that you may have never heard of.
While leading a fall prevention workshop a few years ago, I mentioned that an older person’s walking and balance problems might well be related to the presence of “small vessel ischemic changes” in the brain, which are very common in aging adults. (This is also called “white matter disease.”)
This led to an immediate flurry of follow-up questions. What exactly are these changes, people wanted to know. Do they happen to every older adult? Is this the same as vascular dementia? And how they can best help their parents with cognitive decline?
Well, these types of brain lesions don’t happen to every older person, but they do happen to the vast majority of them. In fact, one study of older adults aged 60-90 found that 95% of them showed signs of these changes on brain MRI.
In other words, if your older parent ever gets an MRI of the head, he or she will probably show some signs of these changes.
So this is a condition that older adults and families should know about. Furthermore, these changes have been associated with problems of consequence to older adults, including:
- Cognitive decline,
- Problems with walking or balance,
- Strokes,
- Vascular dementia.
Now, perhaps the best technical term for what I’m referring to is “cerebral small vessel disease.” But many other synonyms are used by the medical community — especially in radiology reports. They include:
- White matter disease
- Small vessel ischemic disease
- Brain lesions
- Periventricular white matter changes
- Perivascular chronic ischemic white matter disease of aging
- Chronic microvascular changes, chronic microvascular ischemic changes
- Chronic microvascular ischemia
- White matter hyperintensities
- Age-related white matter changes
- Leukoaraiosis
In this post, I will explain what all older adults and their families should know about this extremely common condition related to the brain health of older adults.
In particular, I’ll address the following frequently asked questions:
- What is cerebral small vessel disease (SVD)?
- What are the symptoms of cerebral SVD?
- How is cerebral small vessel disease related to vascular dementia and cerebrovascular accidents?
- What causes cerebral SVD?
- How can cerebral SVD be treated or prevented?
- Should you request an MRI if you’re concerned about cerebral SVD?
I will also address what you can do, if you are concerned about cerebral SVD for yourself or an older loved one.
What is cerebral small vessel disease?
Cerebral small vessel disease (SVD) is an umbrella term covering a variety of abnormalities related to small blood vessels in the brain. Because most brain tissue appears white on MRIs, these abnormalities were historically referred to as “white matter changes” or “white matter disease.”
Per this medical review article, specific examples of cerebral SVD include “lacunar infarcts” (which are a type of small stroke), “white matter hyperintensities” (which are a radiological finding), and “cerebral microbleeds” (which means bleeding in the brain from a very small blood vessel).
In many cases, cerebral SVD seems to be a consequence of atherosclerosis affecting the smaller blood vessels that nourish brain tissue. Just as one’s larger blood vessels in the heart or elsewhere can accumulate plaque, inflammation, and chronic damage over the years, so can the smaller blood vessels.
Such chronic damage can lead the small blood vessels in the brain to become blocked (which starves brain cells of oxygen, and which we technically call ischemia), or to leak (which causes bleeding, which we call hemorrhage and can damage nearby brain cells).
When little bits of brain get damaged in these ways, they can change appearance on radiological scans. So when an MRI report says “white matter disease,” this means the radiologist is seeing signs that probably indicate cerebral SVD.
(Note: In this podcast episode, a UCSF brain health expert explains that although cerebral small vessel disease is probably the most common cause of white matter changes in older adults, it’s not the only condition that can cause such changes. )
Such signs of SVD may be described as “mild”, “moderate,” or “severe/extensive,” depending on how widespread they are.
Here is an enlargement of a good image, from the BMJ article “Changes in white matter as determinant of global functional decline in older independent outpatients.”
What are the symptoms of cerebral small vessel disease?
The severity of symptoms tends to correspond to whether radiological imaging shows the white matter changes to be mild, moderate, or severe.
Many older adults with cerebral SVD will have no noticeable symptoms. This is sometimes called “silent” SVD.
But many problems have been associated with cerebral SVD, especially when it is moderate or severe. These include:
- Cognitive impairment. Several studies, such as this one, have found that cerebral SVD is correlated with worse scores on the Mini-Mental State Exam. When problems with thinking skills are associated with SVD, this can be called “vascular cognitive impairment.”
- Problems with walking and balance. White matter lesions have been repeatedly associated with gait disturbances and mobility difficulties. A 2013 study found that moderate or severe cerebral SVD was associated with a decline in gait and balance function.
- Strokes. A 2010 meta-analysis concluded that white matter hyperintensities are associated with a more than two-fold increase in the risk of stroke.
- Depression. White matter changes have been associated with a higher risk of depression in older people, and may represent a contributor to depression that is particular to having first-time depression in later life.
- Vascular dementia. Signs of cerebral SVD are associated with both having vascular dementia, and eventually developing vascular dementia.
- Other dementias. Research suggests that cerebral SVD is also associated with an increased risk — or increased severity — of other forms of dementia, such as Alzheimer’s disease. Autopsy studies have confirmed that many older adults with dementia show signs of both Alzheimer’s pathology and cerebral small vessel disease.
- Transition to disability or death. In a 2009 study of 639 non-disabled older persons (mean age 74), over a three-year follow-up period, 29.5% of participants with severe white matter changes and 15.1% of participants with moderate white matter changes developed disabilities or died. In comparison, only 10.5% of participants with mild white matter changes transitioned to disability or death over three years. The researchers concluded that severity of cerebral SVD is an important risk factor for overall decline in older adults.
So what does this all mean, in terms of symptoms and cerebral SVD? Here’s how I would boil it down:
1.Overall, older adults with any of the problems listed above have a high probability of having cerebral SVD.
2. But, many older adults with cerebral SVD on MRI are asymptomatic, and do not notice any difficulties. This is especially true of aging adults with mild cerebral SVD.
3. Older adults with cerebral SVD are at increased risk of developing the problems above, often within a few years time. This is especially true of people with moderate or severe cerebral SVD.
How is cerebral small vessel disease related to vascular dementia and cerebrovascular accidents?
The term “vascular dementia” means having dementia that is mostly due to having had problems with the blood vessels in the brain.
(For more on the definition of dementia and vascular dementia, see here: Beyond Alzheimer’s: Common Types of Dementia in Aging.)
The brain has some large blood vessels; when a person develops a clot or bleed related to a large blood vessel, this causes a major stroke, also known as a cerebrovascular accident.
It is possible to get dementia after a major stroke. However, in older adults, it’s probably more common to develop vascular dementia due to injuries to the small vessels of the brain. But again, as I explained above: not everyone with signs of cerebral small vessel disease ends up developing cognitive impairment or dementia.
What causes cerebral small vessel disease?
This is a topic of intense research, and the experts in this area tend to really nerd out when discussing it. (Read the scholarly papers listed below to see what I mean.) One reason it’s difficult to give an exact answer is that cerebral SVD is a broad umbrella term that encompasses many different types of problems with the brain’s small blood vessels.
Still, certain risk factors for developing cerebral SVD have been identified. Many overlap with risk factors for stroke. They include:
- Hypertension
- Dyslipidemia (e.g. high cholesterol)
- Atrial fibrillation
- Cerebral amyloid angiopathy
- Diabetes
- Smoking
- Age
- Inflammation
There is also evidence that Alzheimer’s disease and cerebral small vessel disease frequently co-exist in older adults, and might interact to accelerate cognitive decline.
How can cerebral small vessel disease be treated or prevented?
Experts are still trying to figure out the answers to this question, and research into the prevention of cerebral SVD is ongoing.
Since worsening of white matter disease is often associated with clinical problems, experts are also trying to determine how we might prevent, or delay, the progression of SVD in older adults.
Generally, experts recommend that clinicians consider treating any underlying risk factors. In most cases, this means detecting and treating any traditional risk factors for stroke.
(For more on identifying and addressing stroke risk factors, see How to Address Cardiovascular Risk Factors for Better Brain Health: 12 Risks to Know & 5 Things to Do.)
To date, studies of hypertension treatment to prevent the progression of white matter changes have shown mixed results. It appears that treating high blood pressure can slow the progression of brain changes in some people. But such treatment may be less effective in people who are older than 80, or who already have severe cerebral SVD.
In other words, your best bet for preventing or slowing down cerebral SVD may be to properly treat high blood pressure and other risk factors before you are 80, or otherwise have significant SVD.
Furthermore, experts don’t yet agree on how low to go, when it comes to optimal blood pressure for an older person with cerebral small vessel disease. (This article explains why this has been difficult to determine.)
For now, to prevent the occurrence or progression of cerebral small vessel disease, it’s reasonable to start by observing the hypertension guidelines considered reasonable for most older adults: treat to a target of systolic blood pressure less than 150mm/Hg.
Whether to treat high blood pressure — and other cardiovascular risk factors — more aggressively should depend on an older person’s particular health circumstances. I explain a step-by-step process you can use (with links to related research) here: 6 Steps to Better High Blood Pressure Treatment for Older Adults.
You can also learn more about the research on CSVD and the effect of treating blood pressure here: The relation between antihypertensive treatment and progression of cerebral small vessel disease.
Not necessarily. In my opinion, older adults should only get MRIs of the brain if the following two things are true:
- They are experiencing worrisome clinical symptoms, and
- The results of the MRI are needed to decide on how to treat the person.
For most older adults, an MRI showing signs of cerebral SVD will not, in of itself, change the management of medical problems.
If you have high blood pressure, you should consider treatment. If you are having difficulties with walking or balance, signs of cerebral SVD do not rule out the possibility of other common causes of walking problems, such as medication side-effects, foot pain, neuropathy, and so forth.
What if you’re concerned about memory or thinking problems? Well, you probably will find signs of cerebral SVD on an MRI, just because this is a common finding in all older adults, and it’s especially common in people who are experiencing cognitive changes.
However, the MRI cannot tell you whether the cognitive changes you are noticing are only due to cerebral SVD, versus due to developing Alzheimer’s disease, versus due one of the many other dementia mimics. You will still need to pursue a careful evaluation for cognitive impairment. And no matter what the MRI shows, you will likely need to consider optimizing cardiovascular risk factors.
So in most cases, a brain MRI just to check for cerebral SVD is probably not a good idea.
However, if an MRI is indicated for other reasons, you may find out that an older person has mild, moderate, or severe signs of cerebral SVD. In this case, especially if the cerebral SVD is moderate or severe, you’ll want to consider taking steps to reduce stroke risk, and also to monitor for cognitive changes and increased disability.
What to do if you’re worried about cerebral small vessel disease
If you are worried about cerebral SVD, for yourself or for an older relative, here a few things you can do:
- Talk to your doctor about your concerns. You may want to discuss your options for optimizing vascular risk factors, including high blood pressure, high cholesterol, high blood sugar, smoking, and others. For more on identifying and addressing stroke risk factors, see How to Address Cardiovascular Risk Factors for Better Brain Health: 12 Risks to Know & 5 Things to Do.
- Remember that exercise, a healthy diet (such as the Mediterranean diet), good sleep, stress reduction, and many other non-pharmacological approaches can help manage vascular risk factors. Lifestyle approaches are safe and usually benefit your health in lots of ways. Medications to treat high blood pressure and cholesterol should be used judiciously.
- If an MRI of the brain is clinically indicated — or if one has recently been done — ask the doctor to help you understand how the findings may correspond to any worrisome symptoms you’ve noticed. But if you’ve been worried about cognitive impairment or falls, remember that such problems are usually multi-factorial (i.e. they have multiple causes). So it’s best to make sure the doctors have checked for all other common contributors to thinking problems and/or falls.
If you want to learn still more about cerebral small vessel disease, here are some scholarly articles on the subject:
- CNS small vessel disease: A clinical review (2019)
- Mechanisms underlying sporadic cerebral small vessel disease: insights from neuroimaging
- Causes and consequences of cerebral small vessel disease. The RUN DMC study
- Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (2011)
- Early Cerebral Small Vessel Disease and Brain Volume, Cognition, and Gait
- Cardiovascular risk factors and small vessel disease of the brain: Blood pressure, white matter lesions, and functional decline in older persons
I also recommend listening to this very informative podcast interview, with Dr. Fanny Elahi of the UCSF Memory and Aging Center: 084 – Interview: Understanding White Matter Changes in the Aging Brain.
Note: We’ve hit 300+ comments on this article! So we’re closing comments for this article. Thank you for your interest!
Note: This article has generated a lot of questions from people under age 60. If that describes you, please read below:
- Please read the article on “Early Cerebral Small Vessel Disease,” the full article is available for free. This describes SVD found in people aged 40-75. In this study, 2-3% of participants in their 40s showed signs of cerebral SVD.
- You can check for more recent research on this topic by entering the above article at scholar.google.com, and then click the “Cited by” link to find newer articles that reference this article.
- I do not know much about cerebral SVD in younger adults; this is not the population that I personally treat nor read much about. (I’m already quite busy trying to keep up with research related to older adults.)
- As best I can tell, most of what we currently know about health outcomes related to cerebral SVD is based on the studies of older adults. It is not clear to me whether people with cerebral SVD at younger ages should expect similar outcomes. I will not be able to answer most questions related to cerebral SVD in people under age 60.
- If you are concerned about what caused your MRI findings, or what they might mean for the future, please don’t ask me to tell you, because I don’t have these kinds of answers and I cannot quickly find them online.
- You should start by talking to your usual doctors, and perhaps a neurologist.
- If you would like to learn more, consider finding someone specialized in white matter disease in younger adults (e.g. someone doing and publishing research on this topic). Such experts are usually based at an academic medical center. Good luck!
Venkatesan says
I have already explained about my CSVD problems a few months ago. Though My physical activities have slightly improved my brain function still posing problem. During night & day time during sleep I continuously get dreams followed by headache. Also speaking during sleep. Apart from taking Asprin tab. I m also taking Elesert 100 & Clonazepam.5. But these medications do not make my brain silent. Kindly advice some other remedy. Venkatesan.
Leslie Kernisan, MD MPH says
Sorry but I’m afraid I have no further advice to give. You are 54 and your medical situation is complicated, you previously said you were told it might be Parkinson’s. You will need to keep asking your doctors lots of questions about what they think is causing your symptoms and what might help. You should especially let them know if the treatment doesn’t seem to be working well.
As a general rule, I always caution people who are middle-aged or older to be very careful with benzodiazepines such as clonazepam. They are habit-forming, impair balance (falls are an issue in Parkinson’s), and diminish brain function. Of course, for your situation it’s quite possible that the benefits outweigh the risks, but it may be worth discussing this with your doctor before continuing this medication long-term. I have more on the risks of benzodiazepines here:
How to Stop Ativan
good luck!
Emanuel Borg says
When Ihad the MRI they found that the result is;Subarachnoid spaces and ventricles moderate dilatation. periventicular small vessel ischaemic. Can you please explain to me what it is and what to do.thanking you in advance. i Am 68 years old.
Leslie Kernisan, MD MPH says
The subarachnoid space is between the brain and the skull. Possible reasons why this space may look dilated include developing a condition that causes the body to put more fluid there than usual, or developing some shrinking of the brain.
In the brain, the ventricles are known spaces within the brain, which contain cerebrospinal fluid.
https://en.wikipedia.org/wiki/Ventricular_system
I would recommend you talk to your doctors about what your MRI findings might mean. Most test results — including MRI results — have to be considered in the context of your symptoms and other findings on examination or other studies, before a clinician can tell you “what it means and what to do.”
A neurologist should be able to tell you what might be causing this dilation of the ventricles and subarachnoid spaces, given your health and symptoms. Good luck!
Genevieve Wangsness says
I’m a 75 year old female diagnosed with moderate chronic micro vascular ischemia found on a CT scan after i tripped and fell, hitting my head and needing stitches. All was ok, except for this finding. I am quite healthy, exercise regularly (yoga and walking), have consistently low blood pressure, don’t smoke, take no medications, eat healthy (pescatarian), weigh 140 at 5’3″. Other than trying to lower my cholesterol (omitting dairy?) and losing weight, is there anything else I could do to stop the progression of my moderate condition? I am not a fan of drugs.
Leslie Kernisan, MD MPH says
You could look into other factors that might promote inflammation or other more subtle forms of damage to the body’s organs. This can be related to insulin resistance (not uncommon among older adults), or the composition of one’s gut flora, or even chronic stress. I don’t routinely recommend this to people your age, but it is possible to request testing for inflammatory markers, such as C-reactive protein, homocysteine, and the erythrocyte sedimentation rate. This might provide some insight as to whether a mild inflammatory state might be contributing to your cerebral small vessel disease. Losing weight and finding making lifestyle changes that improve your cholesterol might help.
There are a number of books written for the public, on optimizing cardiovascular health and brain health. I think they sometimes contain claims that aren’t quite supported by scientific evidence, but the nutritional and other lifestyle recommendations might be good for you to consider.
Also, although you are not a fan of medications, I would still recommend you learn more about the likely benefits versus risks of taking a low or medium dose statin. These are usually prescribed to lower cholesterol but also may have some separate benefits on blood flow in the brain. They are generally associated with less cardiovascular risk, despite being associated with a small increased risk of diabetes.
Prestroke statins, progression of white matter hyperintensities, and cognitive decline in stroke patients with confluent white matter hyperintensities
Last but not least, be sure to discuss what you can do with one of your own doctors, so that they can take the specifics of your health into consideration.
Good luck!
Rose says
Although ms dx foll clinical correlation in 30’s and immunotherapy resumes.
Rose says
Sorry just been advised initial dx primary demyelienation (mispelt I think) vs def ms, tho not adem.
Leslie Kernisan, MD MPH says
Sorry but I’m afraid I can’t be of much help, as I don’t know much about multiple sclerosis or other demyelinating diseases. I would recommend asking your treating neurologists for help answering these questions. Neurologists should be familiar with the other conditions that might be confused with MS. If they are unsure, a neurologist specializing in multiple sclerosis would likely be able to answer this question.
You may also find it helpful to try to be more specific about what your question is…this will help the neurologists understand what kind of information you need, or what kind of help you are hoping for.
Good luck!
Rose says
With thx.
Rose says
Hi Dr Kernisan
Wow are you popular! My apologies if my question relates to a former post, though I was only able to read a number and not all.
Whilst you mention expertise predom in studies with older person – have you by chance any comment regarding initial diagnosis of ms, later new findings of infarct followed by chronic microvascular ischeamic changes. Age for all when dx were <40 followed by mid 40's.
Kindest Regards
Trish F. says
I’ve had ongoing,health problems for over 10 years that doctors,just brushed off. Finally this year they have found a few things. I’ve had three brain MRIs over that time. Each one show Cerebral Small Vessel Ischemic Diseaae. I’ve said all along that I was losing my balance,losing my “Smart’s”, had absolutely no stamina, and was in a lot of pain. I always said it was the left side of my brain that wasn’t working with the right side of my brain. I was correct that something was wrong.
I’ve now been diagnosed with;
Occipital neuralgia on the left side of brain
Fibromyalgia
Chronic fatigue Syndrome
Syncope
Unsteadiness
Hiatal hernia
Gastritis
Vertigo
Major depressive disorder
Anxiety
The doctors never list my CSMD. That’s a big cause of a lot of my problems. I believe It’s on the radiology report from my brain x-rays.
I’m only 53. I’ve never smoked, don’t drink, do any drugs , don’t have high cholesterol or high blood pressure, don’t have diabetes with. I just don’t seem to fit the mold.
I’m absolutely miserable all the time. I’m on lyrica, cymbalta, omeprazole, muscle relaxer, atorvastatin (only because high blood pressure runs in my family and dr. wanted to be proactive).
I have passed out and hit my head hard twice. I’m so scared because it seem I failing fast. I have an MBA but at this time I can honestly say I’ve lost 50% of my cognit9ve skills.
I have elevated protein in my spine. It doesn’t show any concern for MS. all doctors just brush me off when I want an answer for that elevated protein in my spine. There is a reason it’s,high nut nobody know why. It’s not elevated grossly high but they put safe ranges on lab reports for a reason.
Will you help me please?
Leslie Kernisan, MD MPH says
Wow, you have been through a lot.
So, I personally don’t have experience doctoring people like you; my patients are much older. But I do know people who have been in your situation, where things feel wrong and in many ways are wrong, but the usual doctors aren’t finding a reason for the problems, and aren’t coming up with effective treatments. Such cases are sometimes referred to as “functional somatic syndromes.” They are probably related to a complicated interplay between a person genetics and body, environmental factors, and lifestyle factors.
Functional medicine is one approach that might help. Anecdotally, I know people who feel this has been very helpful. You would need to find a provider near you. There is information about functional medicine here:
http://drhyman.com/about-2/about-functional-medicine/
You might also want to find an in-person or online community of others suffering from this type of condition, for moral support and also for ideas on how to manage as you cope with this difficult health situation.
In terms of your cerebral small vessel disease, my guess would be that it’s a reflection of the other things going on in your body, rather than the main driving cause of your symptoms. So for instance, if you have something causing irritation, inflammation, or dysfunction in your body’s organs and tissues, that could well cause problems with your brain’s small blood vessels, which would results in signs of SVD on your MRI. This seems more likely to me than the opposite scenario.
Hang in there and keep looking for answers. Hope you find someone to help you feel better soon!
Trish F. says
Thanks for your response. Would having shingles at 51 have set off a bunch of these symptoms? I’ve gone downhill very noticeable since that. I have them on the right side of my face.
Leslie Kernisan, MD MPH says
Anything is possible, especially in people who seem to have very sensitive health. You have already developed a lot of symptoms and issues, so that suggests that your body is quite sensitive to things. So it seems plausible to me that one thing might trigger a cascade of other things.
This is why I think functional medicine might be helpful to you. Those practitioners try to get at the root causes of a person’s fragile health, and they are very comprehensive in their evaluation and proposed treatment strategies. Good luck, I hope you find some good answers soon.
DeAnn Jenson says
I am a 76 year old female who has had numerous lumbar and cervical surgeries in addition to DBS surgery 17 years ago for familial tremors. Due to a number of falls in 2016 I had a CT brain/head w/o contrast scan. Tonight almost a year later I happened to find that report. “Gray/White Matter: Low attenuation in periventricular white matter consistent with chronic small vessel ischemic disease. This concerned me because recently I was hospitalized following a traumatic fall. Because I had fallen and injured by head rather frequently a neurosurgeon was assigned to my case. He has now requested a sleep study, consultation with the pain clinic doctor about my meds. I’m anxious to share with him this information I received from your post. One other fact that I would be interested in your comment on is that I have been incontinent for 8 years and no doctor has been able to tell me why. Could my incontinence be attributed to the cerebral small vessel disease? My blood pressure has always be on the low side (110/65 or so) but recently it has been much higher (135/80) which I have attributed to the stress of caring for an invalid husband. Of course our major concern is the reason why I AM falling so much. Your posts have been very enlightening and I look forward to your reply. Thank you so much for your expertise and willingness to share your thoughts.
Leslie Kernisan, MD MPH says
I’m glad you find this article helpful. I suppose you could share it with your doctors, but I’m not sure they will find it very informative. Most doctors are quite familiar with the finding of cerebral small vessel disease, although they may not know that it’s been associated with certain problems such as depression.
It would perhaps be more helpful if you ask your doctors to explain whether they think the cerebral SVD might be related to your concerns, such as your falls and the incontinence. You can also ask them if your past DBS surgery or other neurosurgical history might be contributing.
Here is an article that explains evaluating falls in more detail: Why Older People Fall & How to Reduce Fall Risk. Most falls in older adults are due to multiple factors, and require a multi-pronged intervention. Strength and balance exercises often help, even if other factors (such as brain changes) are an issue. That’s because strength and balance can be improved through training exercises, whereas many brain changes are hard to reverse.
Regarding incontinence, although the brain does play a role in controlling and coordinating urination, in women incontinence is often related to structural issues affecting the pelvic muscles, the bladder, and the uterus. I have found that urologists specializing in older women often are able to do a more thorough evaluation than PCPs or neurologists, so you may want to consider such an evaluation, if you haven’t already had one.
Otherwise, incontinence is classically associated with a condition called “normal pressure hydrocephalus. (NPH)” This usually is associated with enlarged ventricles on brain imaging and would likely have been mentioned in your radiology report if it was present. A study of older adults found that only 0.2% of participants aged 70-79 met criteria for probable NPH.
Mostly, you need to keep researching and asking your doctors lots of questions, as you are doing. Good luck!
Barbara says
Sorry, I just thought of another question..
after a diagnosis and it’s “mild” is it possible to halt the progression with lifestyle changes? I mean if a person lost weight, doesnt develope hypertension, high cholesterol or diabetes and stopped smoking. I suppose those could be underlying causes. What else besides an aging brain and inflammation can cause it?
Leslie Kernisan, MD MPH says
In people who were not very old, some studies have shown that improving blood pressure control and other factors was associated with less progression of the lesions. I cover the best known risk factors in the articles, and also address some of the other ones in the comments.
Barbara says
Thank you! I’m 59 and when you say “older or elderly” are you referring to me?
You said “In people who were not very old, some studies have shown that improving blood pressure control and other factors was associated with less progression of the lesions.” What age group are you referring to and am I considered a Senior? LOL
Leslie Kernisan, MD MPH says
I have not used the term “elderly” in this article or in the comments.
In the US, the term “older adult” is often used to refer to people aged 65 and older.
https://www.census.gov/newsroom/facts-for-features/2017/cb17-ff08.html
In terms of the health information on this site, I would say it’s generally applicable to people in their sixties and older. So you are borderline.
In terms of slowing the progression of cerebral small vessel disease by reducing blood pressure, in the article I explain that research suggests this is less likely to be effective in people over age 80. So I guess in this particular instance, my writing “people who are not very old” was referring to people under age 80.
Do talk to your doctors about what your particular risk factors might be, and how to manage them.
Barbara says
Hi,
A horrible headache sent me to the ER one night and a CT scan was done. No brain bleed but mild ischemic small blood vessel disease was discovered. I’m 59 years old.
Is it possible to have this without it progressing any further? Does it always progress? Can a person have it but never have any ill effects? I mean, is it just a “given” when you have this? Should we expect to have a stroke etc. Does it ever reverse?
I thought I once read an article where some patients in a study showed no progression and it was actually reversing.
Also, if it can be caused by a single event, (head trauma, migraine headache) how does a radiologist know the differences in its cause?
Can a radiologist be wrong in his findings?
Thanks
Leslie Kernisan, MD MPH says
Radiologists look at images, spot certain features or patterns, and sometimes draw conclusions or say that their findings are consistent with “XXX”. It is certainly possible for a different radiologist to draw different conclusions, especially if the second radiologist is particularly trained or experienced in reading scans of a certain type or body part. If you can get images of your scan given to you, you can take the scan to a different radiologist and request a second opinion.
I suppose that mild small vessel disease might never progress in some people, but given enough time, it usually will. That’s because whatever caused the first signs of damage (whether it’s high blood pressure, inflammation, etc) is likely to continue to affect the person at least somewhat. Furthermore, “aging” is likely to cause it, because aging brings on some inflammation and deterioration of the body’s tissues, and in some people, cerebral SVD is a manifestation of this.
As I explain the article, it’s associated with a higher risk of stroke, but a higher risk does not equal destiny.
I generally advise people to consider mild cerebral SVD as a warning sign that the small vessels of the brain have experienced some strain or damage. You can work with a neurologist or other doctor for help determining what might be your particular most important risk factors, and how best to manage them. Good luck.