What Is White Matter Disease and How to Manage It?

Published on November 18, 2023 .

White matter brain image — Image by Popartic via Shutterstock

White matter disease is a group of diseases in which the density of white matter is diminished. This includes multiple sclerosis, migraine, and HIV encephalopathy. But how do people get this disease and how can it be managed? Let’s find out more.

White matter disease is defined as "diminished density of white matter which is seen on brain computed tomography."
The risk factors of white matter disease include smoking, drinking, diabetes, and hypertension.
In the early stages, patients have no symptoms, but as the disease advances, cognitive impairment and balance disorders may happen.
If you are diagnosed with white matter disease, consult your doctor for healthier lifestyle changes.

White matter disease, or leukoaraiosis, is a neurological disease where the brain has abnormal areas of myelination. Myelin, made up of proteins and phospholipids, is necessary for protecting the neurons. It forms an insulating sheath around the long appendages of neurons. Myelin helps in the rapid communication of nerve impulses. The cell bodies of the neurons form the gray matter, and the areas with myelin sheaths form the white matter. When this myelin starts becoming less dense, it shows up as hyperintensities or lesions on a magnetic resonance image (MRI) scan or computed tomography (CT) scan.

What causes white matter disease?

Generally, as we get older, the blood flow to our brain changes, and people may show signs of white matter disease. Most adults over 90 show signs of white matter disease. However, it is also possible that other diseases can lead to white matter disease.

The white matter disease can be caused due to vascular or non-vascular causes. The vascular causes are diseases of the blood vessels that eventually lead to white matter disease. Some examples of vascular disease are:

Migraine
Small vessel disease
Vasculitis or the inflammation of blood vessels
Atherosclerosis or the buildup of plaque in the blood vessels

Non-vascular causes of white matter disease are:

HIV encephalopathy
Infections like Whipple disease and Lyme encephalopathy
Multiple sclerosis
Vitamin B12 deficiency
Hashimoto encephalopathy

Trauma can also cause white matter disease. After radiotherapy or traumatic injury, people may experience white matter disease. Genetics also plays are role in certain types of white matter diseases, such as vanishing white matter disease.

Apart from a physical exam, your doctor may advise various tests such as MRI scans, blood work, or even genetic testing to diagnose white matter disease and its underlying causes accurately.

What are the risk factors?

Certain lifestyle choices and diseases are considered risk factors. The risk factors of white matter disease include:

Sex. As compared to males, females are at a lesser risk until age 60. However, after 60, females are at a higher risk.
Age. With age, the risk of white matter disease increases.
Hypertension. People with hypertension are at a greater risk of white matter disease.
Diabetes. Diabetes and persistent increase in blood glucose levels increases the risk of white matter disease.
Smoking. Defined as smoking "at least ten cigarettes daily for at least two years."
Drinking. Defined as "a history of chronic alcoholism for ten years."
Homocysteine (HCY). This is an amino acid present in the blood, but high levels of HCY indicate vitamin deficiencies and arterial damage. Levels greater than >15 μmol/L are considered risky.
Low-density lipids-C (LDL-C). The normal LDL-C levels are between 2.07 to 3.36 mmol/L. An increase in LDL-C levels raises the risk of the white matter disease.

How can we manage white matter disease?

As mentioned earlier, several causes can lead to the white matter disease. Doctors take a multi-pronged approach to manage the disease. First, if the disease symptoms are observed, medication for managing the symptoms becomes necessary. People with white matter disease may experience memory problems, slow walking, urinary incontinence, and falls. If there is cognitive impairment, therapies such as behavior therapy, music therapy, or art therapy may become essential.

Next, treatment of underlying diseases becomes crucial. Doctors may prescribe drugs for maintaining blood glucose levels, controlling high blood pressure, or steroids for inflammation, etc. Some underlying diseases, such as multiple sclerosis, show a pattern of relapse and remission. Depending on the phase of the disease, the treatment may change. Consult your doctor periodically to manage the symptoms and progression of the disease.

Can white matter disease be prevented?

A healthier lifestyle can help us in preventing white matter disease. Quitting smoking and drinking in moderation can help in reducing the risk of white matter disease. Apart from medical help for substance abuse, joining local support groups or Alcoholics Anonymous may be necessary for some individuals.

Regular exercise like walking or running improves blood flow to various parts of the body, including the brain. Eating healthier also helps in maintaining brain health. A diet rich in micronutrients, such as vitamin B12 and vitamin D, and minerals, such as copper and zinc, can help maintain brain function.

In summary, white matter disease is decreased density of white matter observed using brain imaging techniques. This disease can be caused by other vascular or non-vascular diseases, such as migraine or HIV encephalopathy. Some risk factors are non-modifiable, e.g., age, but others are modifiable, e.g., smoking or drinking. Adopting a healthier lifestyle can help us maintain our brain health. Consult your primary care provider to discuss more about white matter disease.