title: MRI features of Binswanger's disease predict prognosis and associated pathology.
abstract: OBJECTIVE
  To identify the prevalence of MRI features of Binswanger's disease (BD), specifically MRI with diffuse white matter lesions and scattered multiple lacunes (BD-MRI), and to describe neurological features and pathological outcomes of a community-based cohort study.
  
  
  METHODS
  Of 697 participants (all 75 years old), 503 completed neurological examinations at baseline and were followed-up every 30 months thereafter with MRIs, the mini-mental state examination (MMSE) and the Unified Parkinson Disease Rating Scale-Motor Section (UPDRSM). Data from participants with BD-MRI were compared with those from participants with predominant white matter lesions (WML-MRI), scattered multiple lacunes (ML-MRI), or normal MRIs.
  
  
  RESULTS
  Fourteen BD-MRI patients (2.8%) were detected at baseline. The mean MMSE scores in the BD-MRI, WML-MRI, ML-MRI, and normal MRIs groups were 26.4, 28.2, 28.4, and 28.5, respectively, and the mean UPDRSM scores were 9.1, 1.3, 3.1, and 1.7, respectively. At the 30-month follow-up, mortality rates in the normal MRIs, WML-MRI and ML-MRI were 4%, 9.1%, and 22.2%, respectively, and follow-up MRIs were available for 80%, 82%, and 61% of the participants, respectively. In the BD-MRI, however, five patients were deceased, and only five follow-up individual MRIs were available (33.3%). Autopsies were performed on six of eight BD-MRI brains, and these brains fulfilled the pathological criteria for BD independent of Alzheimer disease pathology. All these six individuals also showed systemic atherosclerosis and renal arterio-arteriolosclerosis.
  
  
  CONCLUSIONS
  The BD-MRI participants had poor prognoses and showed pure BD pathology with advanced systemic vascular disease. BD-MRI appears to be a predictor of vascular neurocognitive impairment.
authors.affiliation: Center of Neurological and Cerebrovascular Diseases, Takeda Hospital Kyoto, Japan ; Department of Health Science, Kyoto Koka Women's University Kyoto, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Akiguchi
authors.affiliation: Institute of Neurology, Medical University of Vienna Vienna, Austria.
authors.forename: Herbert
authors.initials: H
authors.lastname: Budka
authors.affiliation: Center of Neurological and Cerebrovascular Diseases, Takeda Hospital Kyoto, Japan ; Biomedical MR Science Center, Shiga University of Medical Science Otsu, Japan.
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Shirakashi
authors.affiliation: Institute of Neurology, Medical University of Vienna Vienna, Austria.
authors.forename: Adelheid
authors.initials: A
authors.lastname: Woehrer
authors.affiliation: Department of Health Science, Kyoto Koka Women's University Kyoto, Japan ; Biomedical MR Science Center, Shiga University of Medical Science Otsu, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Biomedical MR Science Center, Shiga University of Medical Science Otsu, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Shiino
authors.affiliation: Department of Neurology, Kyoto Katsura Hospital Kyoto, Japan.
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Health Science, Kyoto Koka Women's University Kyoto, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kawamoto
authors.affiliation: Department of Radiology, Danube Hospital Vienna, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Krampla
authors.affiliation: Ludwig Boltzmann Institute of Aging Research, Danube Hospital Vienna, Austria.
authors.forename: Susanne
authors.initials: S
authors.lastname: Jungwirth
authors.affiliation: Ludwig Boltzmann Institute of Aging Research, Danube Hospital Vienna, Austria ; Department of Psychiatry, Danube Hospital Vienna, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Fischer