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In This Episode:
Dr. K explains what to know about cerebral small vessel disease (SVD), a very common brain condition linked to cognitive decline, balance and walking problems, dementia, and other significant health issues. She covers:
- Common terms used by radiologists to describe this condition, such as “white matter disease,””small vessel ischemia,” and others
- What is cerebral SVD
- What are the symptoms that can be caused by this condition
- Risk factors and other potential causes for cerebral SVD
- How to treat and prevent cerebral SVD
- Why it’s not usually a good idea to request an MRI to check for this condition
- What to do if you’re concerned about cerebral SVD for yourself or an older loved one
Related episodes:
084 – Interview: Understanding White Matter Changes in the Aging Brain
002 – What to Do If You’re Worried About Someone’s Memory
004 – What to Do If You’re Worried About Falls
018 – High Blood Pressure Treatment in Older Adults: Research Findings & Practical Tips
Related Resources:
- Cerebral Small Vessel Disease: What to Know and What to Do
- How to Diagnose & Treat Mild Cognitive Impairment
- How We Diagnose Dementia: The Practical Basics to Know
- Why Older People Fall & How to Reduce Fall Risk
- New Blood Pressure Study: What to Know About SPRINT-Senior & Other Research
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Janabelleca says
MRI shows minimal amount of indeterminate T2 hyperintensities in the supratentorial white matter are attributed to mild microvascular disease.
7 x 10 mm prevascular space in the right temporal lobe. No intra or extra-axial space-occupying lesion or collection.
Is this the beginning of vascular dementia? I have some short term memory issues.
Nicole Didyk, MD says
As I’ve mentioned before, an MRI result should not be the only factor in a diagnosis of cognitive decline. One of the most important parts of a dementia diagnosis is a decline in day-to-day function, like missing appointments, forgetting to pay bills, or getting lost in familiar areas while driving. If a person is still functioning just fine, they don’t have dementia.
A lot more goes into the evaluation of cognition than taking a scan. You can read more about that here: https://betterhealthwhileaging.net/how-to-diagnose-dementia-the-basics/
Kelly Sharp says
I am a 58 year old female and recently had an episode that was classed as a TIA. it wasn’t typical but i experienced weakness on one side of my body involving my arm and leg, no facial droop, no slurring of speech just this one sided weakness and light headiness which resolved within the hour. Bloods revealed I had high BP, & High Cholesterol (6.4 overall). I have been on a low dose Blood pressure medication for a few years. I had a brain CT scan with Dye contrast that was clear of any stroke signs, no bleeds or anything else showed up but it revealed I had scatterings of hypodensities in my white matter, more than what would normally be seen in a person of my age. My question is all I have read about is hyperdensities not hypo… I believe they mean different things is that correct? Can this be explained to me please. I am now on a blood thinner, cholesterol and continued with blood pressure medication. I have a low salt diet and have removed nearly all saturated fats. My BP is now around 123/74 and I am feeling great but still confused with my diagnosis. Many thanks
Leslie Kernisan, MD MPH says
Whether the brain changes show up as hypodensities (lighter than usual) or hyperdensities (darker than usual) depends in part on the type of scan and contrast that was used. I wouldn’t worry about the distinction too much. If you have more white matter changes than usual for your age, it’s important to manage BP, choleseterol, diet, exercise, and other vascular risk factors, as you are doing. Good luck!
Tom says
Excellent resource! How about TBIs contributing?
It’s great to recognize immune disorders to contribute. Who knows?
It would be great to remedy this. I think some professionals really are at a lost understanding this if no evidence or lifestyle is contributing ( no high blood pressure, no cardiovascular issues, no diabetes, exercise is consistent. and higher).
What about low pressure contributing (100/69)? What about lower back issues like drop foot?
I personally think marking on someone’s report cognitive decline based on a MRI for mild small SVD is not helpful. Professionals assume you cannot cognate. No cognitive tests were given; one should not assume it is SVD.
Who knows what variables contribute to a fall??
Nicole Didyk, MD says
Thanks for listening to the podcast, Tom! Glad you enjoyed it.
There are many factors that could contribute to small vessel disease, but the major risk factors seem to be those associated with stroke. Age is a risk factor as well. I’m not sure how a foot drop would affect the brain, unless there’s some process that affects brain and peripheral nerves (such as diabetes). Very low blood pressure can affect blood flow to parts of the brain and cause a stroke, but chronic BP in the 100 systolic range is probbaly not harmful and may be protective.
I agree that an MRI result should not be the only factor in a diagnosis of cognitive decline. A lot more goes into the evaluation of cognition than taking a scan. You can read more about that here: https://betterhealthwhileaging.net/how-to-diagnose-dementia-the-basics/
And here’s an article about falls that you might be interested in: https://betterhealthwhileaging.net/8-things-to-check-after-fall-in-aging/
Tarvinder Singh Juss says
Dear Dr,
What is the literature reference to your article on the subject of this podcast (How Cerebral Small Vessel Disease Affects Most Aging Brains), which you allude to at the beginning? The impression I get is that I should be able to locate it easily, but I think I am being a bit obtuse.
Kind regards,
Tarvinder Juss
Leslie Kernisan, MD MPH says
The literature references are embedded as hyperlinks in this related article: Cerebral Small Vessel Disease: What to Know & What to Do. I also list a few specific scholarly references at the end. Hope this helps.
Gaurav Shrivastav says
hv 62 yr old bro, diabetic on medicines. He had a fall on 20 Feb, had fracture n clot. Admitted to nursing home for a week. Then he was OK for a month, later he started forgetting his way back home and gradually was on bed. His mri reoprt is attached, doc has prescribed cholesterol lowering drug without any test, wonder if it’s right medication.
Nicole Didyk, MD says
Sorry to hear about your brother’s difficulties.
I can’t give specific medical advice over the internet, but it may be that the MRI showed some changes in keeping with a stroke. In that case, a cholesterol lowering pill could be in order, to reduce the risk of another stroke.