Memory changes, balance difficulties, and mobility challenges are sometimes associated with white matter disease, a condition that affects a significant portion of people over 60. While there is no cure, management strategies may help support overall brain health.
White matter facilitates communication between different parts of the brain, allowing for the integration of sight, sound, movement, and sensory input. Several disorders and diseases affect white matter.
This guide explores what is currently known about white matter disease, including possible causes, symptoms, and management approaches.
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What is White Matter?
Before understanding the effects of white matter disease, it is crucial to understand what white matter is. The central nervous system, the brain and spinal column, are made up of white matter and grey matter.
Most people imagine grey matter when they imagine a brain—a grey organ with peaks and valleys of flowing tissue. That is because grey matter covers the outside of the brain. However, grey matter, the part of the brain that contains neurons and sends and receives signals to the body, makes up less than half of the brain tissue.
White matter makes up 60% of the brain and sends signals from one part to another. It connects the right and left hemispheres, basal ganglia, cerebellum, cerebral cortex, and spinal marrow.
It uses pathways rich in myelin, the insulating substance that can increase transmission signals up to 30 times.
A good image is to think of the grey matter as computer centers, where information is processed, stored, and remembered. The white matter is the cables connecting all the computers and allowing them to share information. It can be seen as fiber-like cables throughout the brain, connecting different regions.
So, when someone sees a car, one part of the brain sees the image, another knows what the image is, another knows that the image is a word, and another knows that the word is "car." The white matter connects all those pieces, resulting in the thought, "That is a car."
What is White Matter Disease?
White matter disease is a term used to describe conditions that primarily affect the white matter of the brain, often leading to neurological changes.
Damage to white matter causes lesions, which can be seen as bright white spots on a brain MRI. White matter lesions have been associated with an increased risk of stroke and mobility challenges in some individuals.
There are a variety of diseases and disorders associated, including:
- Multiple Sclerosis
- Balo Concentric Sclerosis
- Leukoencephalopathy
- Hypomyelinating Disorders
- Vascular Dementia (unlike Alzheimer's Disease, which is a disease of the gray matter)
- Cerebral Amyloid Angiopathy
- Zellweger Syndrome
- Acute Disseminated Encephalomyelitis (ADEM)
Causes and Risk Factors of White Matter Disease
It is still unclear precisely what causes many white matter diseases. There are a few genetically linked conditions, such as Alexander Disease, but much of what causes these diseases and disorders is unknown.
Some cases of white matter disease have been linked to reduced oxygen supply to the brain over time. This is known as hypoxia and leads to the white matter slowly deteriorating.
Some research suggests that malnutrition related to excessive alcohol consumption may contribute to changes in white matter. While the exact causes are largely unknown, several risk factors, most of which are lifestyle-related, should be considered.
As stated earlier, white matter disease affects 50% of people 60 and older. Therefore, age is a known risk factor. However, the following may also be risk factors:
- Hypertension
- Cardiovascular disease
- Diabetes
- Cigarette smoking
- Excessive alcohol consumption
- Sedentary lifestyle
Recognizing the Symptoms of White Matter Disease
Since white matter plays a critical role in brain communication, damage to these pathways can result in a wide range of neurological symptoms.
With white matter acting as the connections in the brain, damage to the white matter can be significant and far-reaching, affecting:
- Walking: the signal from the brain to the musculature could be interrupted
- Learning: the damaged white matter might not save incoming information
- Memory: the signal to retrieve a memory may get lost in the damaged areas, causing memory lapses, confusion, and slower thinking
- Depression and other mood changes: the emotional connections can become damaged and unable to signal feelings or appropriate response to signals properly
- Instability: caused by a deficit in white matter that damages the body-to-brain signals, can cause a lack of what is known as proprioception
Diagnosis and Testing
The first step in diagnosing white matter disease is a frank and open conversation between a patient and their medical provider. As people age, many can become embarrassed by memory loss, confusion, and mood swings. A patient must be willing to alert their physician to any changes early enough to detect and begin treating white matter diseases.
MRI and CT scans can detect white matter lesions, which may provide valuable insights for diagnosis when combined with a clinical evaluation.
Patients can also receive extensive neuropsychological testing that involves several written and visual tests designed to assess a patient's mental state, cognitive abilities, and emotional functionality.
Treatment of White Matter Disease
Managing underlying health conditions and risk factors is an important part of care for individuals with white matter disease. This is especially true, as few medications or physical treatments are available for this disease. For individuals with white matter disease, healthcare providers may recommend the following strategies to support brain health:
- Control high blood pressure
- Manage diabetes
- Lower vascular risk factors, such as obesity, poor diet, and high cholesterol
Medications for white matter disease include:
- Aspirin and other blood thinners
- Ibuprofen and Naproxen to reduce inflammation
- Steroids to treat MS flares
- Statins to help control cerebral ischemia
- Antidepressants for mood stabilization
Patients with white matter disease might also take part in physical therapy to help maintain balance and walking. While research is ongoing, new treatments for white matter disease are still several years away. Current research on treatment is focusing on:
- Gene therapy has been shown to work in mice but is not yet being researched in humans.
- ABBV-CLS-7262, Fosigotifator, and Guanabenz are new medications currently in early clinical trials.
Preventing White Matter Disease
While there is no guaranteed way to prevent white matter disease, adopting a healthy lifestyle and managing risk factors may support brain health and overall well-being.
- Exercise a minimum of 30 minutes per day for three days each week.
- Diet modifications, including an anti-inflammatory diet, low salt diet, and low-fat diet
- Mental stimulation, such as crosswords and other word or math puzzles, and learning new skills can decrease the risk of white matter disease.
- Mindfulness practices
- Blood pressure control
- Cholesterol control
- Diabetes management for those who have diabetes
- Smoking cessation
- Avoiding, or at least limiting, alcohol consumption
Regular medical check-ups can also be beneficial as a physician can routinely assess the patient to screen for early indicators of white matter disease.
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Key Takeaways
- White matter makes up 60% of the brain and connects different parts of a functioning brain, thus allowing the various areas to communicate.
- White matter disease is observed in a significant portion of individuals over 60. While certain lifestyle modifications may help support brain health, more research is needed to determine their role in prevention.
- White matter disease affects walking, balance, cognition, mood, and proprioception.
- While the exact cause is unknown, risk factors include hypertension, diabetes, cardiovascular disease, cigarette smoking, excessive alcohol consumption, and a sedentary lifestyle.
- Prevention entails a healthy lifestyle, including exercise, healthy brain habits, and a nutritious diet.
- As with any brain disease, white matter disease presents multiple challenges. Patients and their families should work closely with healthcare providers to ensure proper treatment and prevention.
- With this disease so common, it is essential for patients and their physicians to be aware of white matter disease, discuss it, and proactively work to ensure proper brain health for everyone.
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