L.J. Rohan

L.J. Rohan


Cerebral Small Vessel Disease. Might You Have It?

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).”

cerebral small vessel disease

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:

  1. no noticeable symptoms;
  2. moderate symptoms; or
  3. 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.
Meditation App - LJ Rohan

Cerebral Small Vessel Disease. Might You Have It?

A number of years ago, before I went back to school to study gerontology, I began noticing articles in a variety of publications suggesting that exercise might just be the key to unlock the door to vibrant health—mentally and physically– as we enter the second half of our lives. As I write this, we now know beyond all doubt that exercising every day is the key to dynamic aging. It will effectively disrupt aging and can stave off a vat full of health problems. In two past posts, Shake Your Booty and The Rhythm of the Drums, I explored the latest research citing dancing as one of the outstanding ways to lay down new tracks in our aging brain and grow new brain cells along with sleeker muscles.

If you ever participated in your high school’s annual musical production, or took modern dance or ballet because your mother forced you to, you will remember those students who never got the steps, and who had the grace of a spastic earwig. I confess to being one of those students. Therefore it was with no expectations, and little hope, that I signed up for tap class. The first semester wasn’t pretty, I couldn’t cotton on to this kind of dance; so different from the free-form rock and roll dancing I knew. I would sit in my car after class and cry, disheartened that the parade of life had passed me by and that, maybe, I was too old to get this.  Same experience for the second and third semesters, but by the beginning of the fourth, I noticed a small but encouraging change: I could remember how to execute some of the steps after a few tries, and some days both feet would behave for most of the class. Finally, I could keep up with the routine. My teacher, Vicky, a life-long dancer near my own age, who is demanding but very kind, never gave up on me. My fellow tappers were also free of judgement and full of encouragement. The continuously positive environment was the reason I stayed, unlike years before when a ballet teacher shamed me in front of the class for being such a hopeless beginner.  

Shuffle-ball-change by double-toe-tap, I improved. Some weeks it all flows, and other weeks I just give up and make up my own steps while the others tap out a perfect routine. Over time I learned to joke and laugh at my mistakes, and everyone laughed with me. I gave up trying to be perfect, and let the over-achieving aspect of L.J. take a break on the bench.

As our time together as a class has increased, everyone has lightened up, we laugh more, and have a lot of fun. Some days we follow class with lunch together. I look forward to my class each week, and miss it when summer comes. About the same time I could follow along fairly well, I noticed my mind felt clearer, a little sharper. Now, even when I am tired I think better, and my thoughts seem more organized. From my research I know the tracks I began laying in my brain two years ago have gone from resembling noodles, to ones stronger than cardboard, to pathways now as strong as wood. That’s only one step away from making permanent steel tracks. Maybe then I can get the routine down on the second or third try. At this moment, I am so grateful I didn’t give up, that I found a new form of exercise I enjoy.  

And, I expanded my world with new friends who share my passion for aging vibrantly.

 Until next time…Be Vibrant!