Cerebral small vessel disease. You may know it by one of a handful of terms: white matter disease, small vessel ischemic disease, lacunar infarcts, white matter hyperintensities, or Leukoaraiosis. Cerebral small vessel disease (CSVD) encompasses a group of changes and developments (abnormalities) in the small blood vessels of the brain. Today I want to talk about the signs of cerebral small vessel disease and some promising life choices we can make to keep our brains healthy.
Recent reporting by Leslie Kernisan, MD, MPH,* and research done by Dr. Vincent Mok for the Journal of Stroke both note seeing white matter changes, (historically, and still today, called “white matter changes”) when viewing brain tissue on an MRI. Dr. Mok writes, “Lacunar infarcts (small strokes), white matter hyperintensities (these are seen during an MRI), and cerebral microbleeds [meaning bleeding in the brain from a very small blood vessel] are considered various manifestations of cerebral small vessel disease. These lesions are associated with a plethora of disabilities (e.g., stroke, cognitive impairment, depression, gait disturbances, urinary symptoms).”
What Causes Cerebral Small Vessel Disease?
What causes CSVD to develop? That source of all disease: chronically high inflammation. After existing in our bodies for years, and accelerating the development of sticky plaque in our blood vessels and heart, inflammation leads to deposits of plaque, like tiny time bombs, in our brains. The damage accumulates and the small vessels in our brains become blocked – just like in a major artery. These blocks deprive our brain of nourishing blood to keep it humming in perfect tune. Blockages may allow the small vessels to leak blood into our brain tissue, resulting in a brain hemorrhage. Other conditions can also produce white matter changes, but CSVD tops the list of probable causes.
What are the Key Symptoms of CSVD?
We classify CSVD into three levels:
- no noticeable symptoms;
- moderate symptoms; or
- severe symptoms.
Many older adults with CVSD have no noticeable symptoms. Those we notice in folks with moderate to severe CSVD include:
- Cognitive Impairment: When tested, those seniors with CVSD scored worse on the M-MSE, a standard exam given to test cognitive function. Vascular cognitive impairment is the term you might hear in relation to cognitive impairment and cerebral small vessel disease.
- Walking or Balance Issues. Research shows a direct link between increased problems with overall mobility – including standing still and keeping our balance, and a disturbance in our walking and carriage when white matter lesions exist in our brains. Those of us with moderate to severe CVSD experience a noticeable downshift in our walking and balancing abilities.
- Stroke Risk Increase. A study analyzing many studies found a 50% increase in the risk of having a stroke when white matter hyperintensities were present in the brain.
- Developing Depression. People, who, even at an earlier age never experienced depression, may become depressed as a result of white matter changes.
- Vascular Dementia, Dementia, and Alzheimer’s Risks. Scientists also find an increased risk and/or increase in the severity of all forms of dementia (including Alzheimer’s) as CSVD develops and changes the neurological landscape in our brains.
The Origins of CSVD
That’s a tough question, because CSVD, as Dr. Kernisan says, “is a broad umbrella term that encompasses many different types of problems with the brain’s small blood vessels.” What we do know is that many of the factors contributing to the development of CSVD also fall under the list of factors that increase our chances of having a stroke. These include:
- Our age
- Amyloid plaque buildup in the brain
- Irregular or rapid heartbeat (atrial fibrillation)
- High blood pressure (Hypertension)
- High cholesterol
The Good News-What We Can Do
Now, for some good news!
Research shows when we vigorously attend to bringing our bodies back into balance by treating the above risk factors, our chances of developing CSVD will go down. More easily within our control are two of the key contributors, smoking and hypertension. Reams of articles exist on the evils of smoking; I won’t repeat that data. When it comes to hypertension, the evidence tells us that getting our systolic BP (the top number in a reading) down from 160-180 to 140-150 decreases our risk by the greatest margin. According to the experts in several studies, optimum blood pressure is now less than 150, and ideally in the 140s or below, over 90. That’s the goal we must work toward!
In second place, we must wrestle down our cholesterol and/or diabetes numbers. We can do this by adding regular exercise, which raises our heart rate to 85% of our maximum for forty-five minutes to an hour on most days. The formula for our opening power move there is 220 minus your age.
Next, when we adopt the Mediterranean diet as our preferred eating plan, begin taking a tailored regime of supplements (overseen by our DIFM or RDN)*, get good sleep, and actively reduce our stress, we go for the knockout punch. These choices could be just the life changes needed to send both conditions, not just reeling to the corner of the ring, but out of the arena completely.
Even better good news comes from the benefits these life choices have on slowing down the build-up of amyloid plaque, and easing our heart rhythms into a normal beat.
Lastly, what about an MRI to detect CSVD?
The doctors say, not really a good idea.
Why? Because an MRI can’t discern if the cognitive changes you might be experiencing are only due to CVSD, might be a precursor to Alzheimer’s, or a shopping bag full of other types of dementia. A detailed cognitive evaluation will still be needed to laser in on root causes.
Unknowns about CVSD still exist. Here, I offer some understanding of what you might be seeing in yourself, or in loved ones. More advanced research about this disease becomes available every day. The more we know about CVSD, the more we can proactively make positive changes to stave off its development in all of us.
Until next time … Be Vibrant!
* DIFM: Dietitians in Integrative and Functional Medicine/ RDN: Registered Dietitian Nutrition