A brain disease is referred to as subcortical arteriosclerotic encephalopathy ( SAE ). It is also known as Binswanger’s disease.
What is subcortical arteriosclerotic encephalopathy?
Subcortical arteriosclerotic encephalopathy (SAE) is a brain disease caused by vascular changes such as hardening of the arteries ( arteriosclerosis ). Damage occurs in the subcortical area under the cerebral cortex. The disease is also known as multi-infarct dementia, vascular encephalopathy, and Binswanger’s disease. For hypervitaminosis in English, please visit gradphysics.com.
Subcortical arteriosclerotic encephalopathy was first described at the end of the 19th century by the psychiatrist and neurologist Otto Ludwig Binswanger (1852-1929) from Switzerland. Subcortical arteriosclerotic encephalopathy is the most common form of vascular dementia. It is one of the encephalopathies and is associated with arterial hypertension. It also results in microangiopathy.
Subcortical arteriosclerotic encephalopathy is caused by arterial hypertension that has progressed for years, in which the arterioles of the central nervous system (CNS) are continuously damaged by fibrinoid necrosis. This results in tissue destruction. Because the small blood vessels are affected as a result, the affected structures can no longer be properly supplied. This leads to extensive demyelination of the marrow.
Furthermore, thromboembolic microinfarcts occur in the marrow, in the ventral brainstem and in the basal ganglia. In earlier years, the demyelination of the marrow layer was considered the sole reason for the development of dementia symptoms. According to recent research, however, dementia does not develop at the same time as the damage to the marrow. Instead, neuropathological changes occur that are similar to Alzheimer’s. So far, however, the exact cause of the disease has not been determined.
The affected patients with subcortical arteriosclerotic encephalopathy often already suffer from diabetes ( diabetes mellitus ), arterial hypertension or infarcts in several brain sections.
Symptoms, Ailments & Signs
In its initial stage, subcortical arteriosclerotic encephalopathy takes an insidious course and progresses in spurts. Parkinson’s-like symptoms are considered to be the earliest symptom of SAE. This leads to tremors, immobility and rigidity. In addition, cognitive traits such as concentration, attention and memory are reduced.
However, the old memory is hardly affected. In contrast, new information can only be processed inadequately. Those affected are therefore hardly able to cope with new situations. However, they continue to succeed in routine work and carry it out meticulously.
In some patients, after a few years, an affective and intellectual flattening occurs, which is associated with neuropsychological disorders. Vascular dementia often occurs as subcortical arteriosclerotic encephalopathy progresses. Other typical symptoms of SAE are bladder disorders, in which the patients suffer from urine leakage and urinary incontinence, and gait disorders. The latter are characterized by a clumsy, wide-legged and unsteady gait.
Furthermore, there is a spastic increase in muscle tone. In addition, patients suffer from subcortical dementia, which leads to a Parkinson-like loss of drive and slowing down. Paranoia and hallucinations are not uncommon.
Diagnosis & course of disease
Diagnosis of subcortical arteriosclerotic encephalopathy can be made using imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI). With these methods, extensive demyelination of the marrow layer and lacunar infarcts can be easily recognized. These appear as whitish foci around the ventricles. The differential diagnosis is also important. For example, similar symptoms can occur in Alzheimer’s disease, multi-infarction dementia, multiple sclerosis, HIV encephalopathy, cerebral edema or radiation damage.
When subcortical arteriosclerotic encephalopathy progresses to vascular dementia, the patient’s life expectancy is shortened. The mortality rate is higher than in Alzheimer’s dementia. In addition, there are often serious falls or confinement to bed.
Subcortical arterisclerotic encephalopathy is always associated with severe limitations in movement. As the disease progresses, the person affected can walk more and more poorly and eventually becomes immobile. There are also frequent falls and accidents that leave the patient bedridden. Delayed wound healing and constant lying down can cause secondary symptoms such as oedema, circulatory disorders and inflammation.
Prolonged confinement to bed also impairs cognitive perception and, over time, causes psychological problems and personality changes. From there, subcortical arterisclerotic encephalopathy can cause bladder dysfunction. Urinary leakage and incontinence often occur.
The dementia then progresses and causes paranoid-hallucinatory symptoms. The life expectancy of the patient is usually reduced. The treatment of the brain disease usually proceeds without major complications. However, the prescribed sedatives can cause severe side effects.
Addictive behavior can also develop in connection with existing mental illnesses. Occupational therapy can cause frustration and anxiety in those affected, as progress is usually made very slowly. Physiotherapy carries the risk of temporary tension or bruising, but is otherwise symptom-free.
When should you go to the doctor?
Persistent or progressive memory impairment is a cause for concern. A doctor should be consulted so that the cause can be clarified. Impairments in attention, general memory, and a decrease in mental performance should be investigated. If the affected person’s resilience decreases, his personality changes or if there are abnormalities in his behavior, a doctor is needed. A trembling of the limbs, unsteady gait or disturbances in the movement sequences are further signs of a health impairment. A doctor’s visit is necessary so that the cause can be investigated.
If the person concerned suffers from uncontrolled loss of urine, increasing feelings of shame or withdraws from social life, there is a need for action. In case of rigidity or immobility, a doctor should be consulted immediately. In severe cases, an emergency service must be alerted. Hallucinations, listlessness and irregularities in the muscular system are further symptoms of subcortical arteriosclerotic encephalopathy.
You must be presented to a doctor as soon as possible so that medical care can take place. Exhaustion, being bedridden and persistent exhaustion should be presented to a doctor for examination. Mental and emotional problems, a decrease in well-being and a general feeling of illness should be discussed with a doctor. If the everyday obligations can no longer be carried out independently, the person concerned needs help.
Treatment & Therapy
Because the causes of subcortical arteriosclerotic encephalopathy are still largely unknown, there is no specific therapy for its treatment. Surgical interventions cannot bring about any improvement either. Even treatment with medication is rarely successful. For this reason, avoiding long-term or short-term hypertension is the focus of therapy. These represent a significant risk factor for subcortical arteriosclerotic encephalopathy.
Furthermore, the extrapyramidal movement disorders, which are a typical feature of SAE, are treated. The focus of the therapy is to compensate for gait disorders, balance disorders and coordination weaknesses. It is important to start treatment as early as possible.
Another pillar of SAE therapy is occupational therapy. It is particularly useful for the treatment of coordination disorders. Incontinence counseling and the administration of appropriate medication are also provided. The supply of incontinence supplies helps to make life easier for patients, as does their relatives.
If the patient suffers from restlessness, sedative drugs such as haloperidol, melperone or clomethiazole can be administered to calm him down at night. Another important part of treatment is cognitive training. This can also be done jointly by occupational therapists and psychologists.
The aim is to give the patient better orientation and more independence and personal responsibility. If behavioral disorders are present, therapists now prefer non-pharmacological interventions. If these treatment measures are not sufficient, the patient is given appropriate medication.
Since the causes of subcortical arteriosclerotic encephalopathy are largely unknown, targeted prevention is hardly possible. There are also no drugs that can prevent or at least delay SAE or vascular dementia. Although certain preparations are offered, their harm usually outweighs their benefit.
SAE cannot be completely cured. The progression of the disease can only be slightly influenced by the administration of medication. Due to the chronic character, an accompanying aftercare is useful. A largely normal life is the goal of follow-up therapy approaches. The patient’s quality of life should be stabilized and his or her independence should be maintained for as long as possible.
In the case of subcortical arteriosclerotic encephalopathy, follow-up care is physiotherapeutic and psychotherapeutic. Simultaneous care by a neurologist is also advisable. Physiotherapeutic exercises aim to improve the patient’s mobility. Existing vascular diseases require medical treatment. This reduces the risk of an SAE. When using medication, a specialist must check the tolerability.
Side effects must be recognized and treated early. Follow-up care also affects relatives. You will receive advice from the therapist on how to deal with the patient on a day-to-day basis. The affected person has the opportunity to take precautions themselves: A healthy lifestyle can reduce the likelihood of SAE. A varied diet and avoiding nicotine or alcohol have a positive effect. A change in diet, on the other hand, is part of the aftercare. After receiving the diagnosis, the patient should refrain from cigarettes or too much alcohol.
You can do that yourself
Once this disease has been diagnosed, therapies can only alleviate the symptoms and slow the progression of the disease. To do this, patients must carefully follow the treatment plans of their treating physicians, take the prescribed medication regularly and keep their physical therapy appointments. It is possible that keeping appointments is difficult due to the reduced short-term memory, which is why the patients are often dependent on help and care at an early stage.
Visiting a psychologist or psychiatrist can also help. On the one hand, to cope with the stressful situation of the illness, on the other hand, to take part in cognitive training that is intended to prevent or slow down further memory loss. Family members may also benefit from accompanying psychotherapy, since caring for a person with subcortical arteriosclerotic encephalopathy can be very stressful.
In any case, the high blood pressure that may be the cause of the disease must be permanently and consistently reduced in order to avoid further damage. This means that the patient can still do a few things themselves in addition to the appropriate medication in order to improve their situation. This includes, for example, abstaining from alcohol and nicotine. Especially nicotine closes the vessels and thereby exacerbates the subcortical arteriosclerotic encephalopathy. The intake of omega-3 fatty acids, on the other hand, is advisable. There are fish oil capsules on the market that contain these fatty acids, but linseed oil is also a good supplier of omega-3 fatty acids.