Pure Subcortical Arteriosclerotic Encephalopathy (Binswanger’s Disease): A Clinicopathologic Study

Abstract

We studied 14 cases of pure subcortical arteriosclerotic encephalopathy selected from the autopsy files (c.f. part 2) in order to single out the characteristic clinical features (average age: 80.9 years). Nine cases were from a prospective study of dementia. The longest observation time was 18 years. The main findings were: (i) previous chronic hypertension, variable and declining blood pressure and a high ischemic score in the late symptomatic phase; (ii) bilateral multifocal decreases in cerebral blood flow; (iii) gradually progressive, fluctuating mental changes (forgetfulness, abulia, emotional lability, impaired higher cortical functions) and disorders of motility (small-stepped gait, pseudobulbar palsy, urinary incontinence), pure motor strokes, with later dementia and immobility. We conclude that insidious disorders of mentation and motility combined with lacunar strokes in elderly individuals are diagnostic clues to subcortical arteriosclerotic encephalopathy.