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Cerebral White Matter Changes and Geriatric Syndromes: Is There a Link?

¹ Hebrew Rehabilitation Center for Aged, Boston, Massachusetts.
² Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
³ Division of Aging, Harvard Medical School, Boston, Massachusetts.
⁴ Department of Internal Medicine, National Taiwan University Hospital, Taipei.

Address correspondence to Lewis A. Lipsitz, MD, Hebrew Rehabilitation Center for Aged, 1200 Centre Street, Boston, MA 02131. E-mail: lipsitz{at}mail.hrca.harvard.edu

Cerebral white matter lesions (WMLs), also called "leukoaraiosis," are common neuroradiological findings in elderly people. WMLs are often located at periventricular and subcortical areas and manifest as hyperintensities in magnetic resonance imaging. Recent studies suggest that cardiovascular risk factors are associated with the development of WMLs. These lesions are associated with different geriatric syndromes such as falls, executive cognitive impairment, depressive symptoms, and urinary incontinence. Damage to associative pathways in frontal and subcortical regions due to hypoperfusion may disrupt frontal executive, motor control, and other systems, resulting in these manifestations. WMLs are associated with substantial disability and should not be considered a benign and silent condition as once believed. Interventions addressing cardiovascular risk factors should be undertaken in early or mid-life in order to prevent late-life functional impairment associated with WMLs. After these lesions develop and impair executive cognitive functions, the patient's ability to comply with a complex risk reduction program may be significantly compromised.