Psychiatric and behavioral aspects of dementia of the Binswanger type

Abstract

Binswanger's disease or subacute arteriosclerotic encephalopathy is characterized by diffuse demyelination of the white matter together with lacunar lesions in the basal ganglia and brain stem. Clinically it is a dementing illness associated with vascular riskfactors together with varied clinical and radiological abnormalities. The clinical features of Binswanger's disease are highly variable and the psychiatric and behavioral manifestations have been less well described. Review of the literature together with the study offour cases revealed four symptom-clusters, namely, late-onset paranoid psychosis, confusional state, depression and a behavioral syndrome of the frontal lobe type. However, the symptomatology cannot be regarded as mutually exclusive since features may overlap. The symptoms may precede the intellectual deterioration and motor disturbances that are seen with Binswanger's disease. White matter lesions and, hence, cortical-cortical and cortical-sub-cortical connectivities in the genesis of psychosis, is potentially an interesting topic.