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In This Episode:
Dr. K talks with neurologist Fanny Elahi, MD PhD, about cerebral small vessel disease and other issues related to white matter changes in the brain. Dr. Elahi sees patients and conducts research at UCSF’s Memory and Aging Center, and is an Assistant Professor of Neurology at UCSF. They discuss:
- What is the white matter in the brain, and why it often changes or is damaged with aging
- The relationship between white matter changes and cerebral small vessel disease
- How white matter changes can be thought of as a form of “scarring” in brain
- Why these brain changes can affect memory, thinking, and/or falls
- What we know about the prevention and treatment of these changes
- How white matter changes relate to vascular dementia, Alzheimer’s and other causes of dementia
- How the UCSF Memory and Aging Center evaluates white matter changes
- What is vascular parkinsonism
- What to consider for younger people with white matter changes on MRI
- Her recommendations on maintaining the brain and its blood vessels
- Ongoing research projects at UCSF and elsewhere that listeners may be able to participate in
Related episodes:
078 – Interview: The Biology of Aging & Longevity
072 – Cognitive Aging: How Memory & Thinking Change as One Gets Older
048 – How Cerebral Small Vessel Disease Affects Most Aging Brains
Related Resources:
- Cerebral Small Vessel Disease: What to Know & What to Do
- Research Opportunities at the UCSF Memory & Aging Center
- Developing biomarkers for small vessel brain disease: the Mark VCID consortium
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Nick says
It’s interesting to hear about the slow down of the repair process due to aging. We know when we exercise physically, we improve our fitness. Would the same process work if we do mental exercises to improve our brain repair function? For example, if we solve puzzles or play chess on a regular basis, is it possible to improve the effectiveness of small blood vessels feeding blood to the brain cells? There are articles suggesting mental exercises could reduce the chance of getting dementia, but I don’t know if there ‘s any science behind it.
Given the current recommendations is reducing the risk factors (blood pressure, cholesterol ,diabetes, …), I am just wondering if any research has been done on the effectiveness of mental exercises on CSVD. Thanks.
Nicole Didyk, MD says
We don’t have as much data about cognitive exercises and their benefit for brain health as we do about physical exercise. When it comes to cerebral small vessel changes (aka CSVD or white matter changes), the scientific article I found didn’t reveal a benefit in preventing small vessel change progression.
You can read more about treatments for CSVD here: https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.024150 That article is from the “Stroke”, an American Heart Association journal.
My advice is, despite a lack of solid scientific evidence, brain exercise is not a waste of time, and should be balanced with physical exercise and social interaction. It may not be shown to reduce white matter changes but can definitely improve quality of life and have other benefits.
Thanks for commenting!
TINA says
Can I ask what -‘previous small vessel ischaemic changes’, on a CT scan might mean?
I have an MRI to.come hopefully due to ongoing Sinus issues and headaches.
Thank you
Nicole Didyk, MD says
Small vessel ischaemic change, also known as microangiopathic or microvascular ischaemic change is an umbrella term for changes to the small blood vessels in the brain. It’s usually seen in those with stroke risk factors such as high blood pressure, high cholesterol, diabetes, smoking, or older age.
When I see a patient with small vessel change on their brain CT or MRI, it’s a good time to review those risk factors and how to manage them. Good luck with your scan!
Rhian says
I am 43 and diagnosed with WMD yesterday after contrast scan. Very scared of what my future may look like. What can I do to stop it getting worse?
Nicole Didyk, MD says
I’m sorry that you’re feeling scared and it’s great that you’re thinking about how to be proactive.
Dr. K has some great resources about white matter change, also known as small vessel disease, on the website. You’ll find advice about what to do here: Cerebral Small Vessel Disease Affects Most Aging Brains (Here’s what to know & do) , and this podcast: 048 – How Cerebral Small Vessel Disease Affects Most Aging Brains
There are definitely ways to reduce the risk of small vessel disease, including exercise, healthy eating and talking to your doctor about your blood pressure and cholesterol. I hope that as you learn more, you’ll feel empowered to make the best choices for your brain!
Kevin Corner says
Hi I have recently been diagnosed with small vessel disease of the brain but I am only 55 years of age.
I have in the past had small spells of feeling unsteady on my feet, my mood has been very low at times and I suffer from lack of motivation which is out of character to the rest of my life. I was also 2 years ago diagnosed with mild dilated cardiomyopathy but I’m not sure if the two are related and not sure where I go from here being only 55.
Can you offer any specific advise.
Thank you
Kevin
Nicole Didyk, MD says
Small vessel disease can be associated with changes in walking and depression (https://pubmed.ncbi.nlm.nih.gov/32715831/). The dilated cardiomyopathy might be related to the brain issue (if both are caused by blocked or narrowed arteries), or may be a separate process.
Don’t lose hope! Small vessel disease appears to be caused by the same processes that cause heart attack and stroke, so making changes to reduce your cardiovascular and cerebrovascular risk profile could help prevent progression! You’ve probably heard that exercise, eating a Mediterranean diet, seeing your doctor about your blood pressure and cholesterol, can all help reduce cardiovascular risk. I’m sorry my advice isn’t more specific but working with your health care team, I’m sure you’ll be able to develop a lifestyle plan that will move you in the right direction.
Bob Hopkins says
where is there a center of excellence on white matter disease (WMD) in the northern New Jersey area or nearby? we need help in identifying the cause of white matter disease and what to do to slow or reverse the WMD progression by addressing the cause
Nicole Didyk, MD says
Hi Bob and thanks for your comment. I couldn’t find a center of excellence for white matter disease, but it most likely would be something that a stroke or dementia research center would include.
Check out the Rutgers Brain Health Institute: https://brainhealthinstitute.rutgers.edu/
Kimberly says
Great podcast, thank you. I am in my early 50’s and have been having memory and cognitive issues for some years now, recently documented by neuro-psych testing and an MRI with one finding of “Nonspecific white matter changes, possibly reflecting early chronic small vessel ischemic disease”. Cognitive and memory deficiencies are affecting my ability to work, made worse by the fact that my symptoms seem to be exacerbating bi-polar 1 symptoms. Are you aware of any specialists that focus on any part of this and/or any studies in which I may participate? (Minute 22 of the podcast really resonated in terms of what I’m experiencing). Thank you!
Nicole Didyk, MD says
Hi Kimberly and I’m sorry to hear about the changes you’re noticing. Glad you enjoyed the podcast.
This website has a list of clinical trials that might help you to find one in your area that you could enroll in: https://clinicaltrials.gov/ct2/show/NCT04318119
Kimberly says
Thank you!
caroline payne says
Hi, I wish my husband would help more round house!
Nicole Didyk, MD says
Many women would probably share this sentiment. I’m not sure if white matter changes could be blamed for that behaviour!
Jane Denny says
Pls help me! No one seems to be doing anything for me except sending me for multiple MRIs. I am 45 years old and have had many TIAs and 3 strokes. CSVD and white matter changes have been thrown around. Yet I have had no definitive diagnosis. I am terrified of dementia and the results of my next stokes. I exercise, eat fairly well, do not smoke nor drink. I take bp plavix and Cholesterol medication as preventative measures but the levels for those things are relatively good. How do I slow this progression and prevent another stroke? I pray that you’ll read and respond. All the best, Jane
Nicole Didyk, MD says
I can understand being concerned about another stroke, and it sounds like you’re on the right track with managing risk factors like high blood pressure, high cholesterol and being on an anti-platelet agent. It’s unusual for someone in your age group to have multiple strokes, but some strokes occur with no obvious cause. An evaluation at a stroke clinic would be valuable to make sure that there’s no other underlying cause that your team has overlooked (like a heart defect that can predispose to stroke, or an unusual blood clotting condition that can do the same).
If all of these issues have been checked out, then it would be a matter of continuing to do your best along with your healthcare team to prevent another event. The Heart and Stroke foundation in your area may have support groups or information that would help, and you can contact them here.