Better Health While Aging

Practical information for aging health & family caregivers

Cerebral Small Vessel Disease:
What to Know & What to Do

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Signs of cerebral small vessel disease. From Inzitari et al, BMJ. 2009 Jul 6;339:b2477. doi: 10.1136/bmj.b2477

This article is about the most common aging brain problem that you may have never heard of.

While leading a fall prevention workshop a few years ago, I mentioned that an older person’s walking and balance problems might well be related to the presence of “small vessel ischemic changes” in the brain, which are very common in aging adults. (This is also called “white matter disease.”)

This led to an immediate flurry of follow-up questions. What exactly are these changes, people wanted to know. Do they happen to every older adult? Is this the same as vascular dementia? And how they can best help their parents with cognitive decline?

Well, these types of brain lesions don’t happen to every older person, but they do happen to the vast majority of them.  In fact, one study of older adults aged 60-90 found that 95% of them showed signs of these changes on brain MRI.

In other words, if your older parent ever gets an MRI of the head, he or she will probably show some signs of these changes.

So this is a condition that older adults and families should know about. Furthermore, these changes have been associated with problems of consequence to older adults, including:

  • Cognitive decline,
  • Problems with walking or balance,
  • Strokes,
  • Vascular dementia.

Now, perhaps the best technical term for what I’m referring to is “cerebral small vessel disease.” But many other synonyms are used by the medical community — especially in radiology reports. They include:

  • White matter disease
  • Small vessel ischemic disease
  • Brain lesions
  • Periventricular white matter changes
  • Perivascular chronic ischemic white matter disease of aging
  • Chronic microvascular changes, chronic microvascular ischemic changes
  • Chronic microvascular ischemia
  • White matter hyperintensities
  • Age-related white matter changes
  • Leukoaraiosis

In this post, I will explain what all older adults and their families should know about this extremely common condition related to the brain health of older adults.

In particular, I’ll address the following frequently asked questions:

  • What is cerebral small vessel disease (SVD)?
  • What are the symptoms of cerebral SVD?
  • How is cerebral small vessel disease related to vascular dementia and cerebrovascular accidents?
  • What causes cerebral SVD?
  • How can cerebral SVD be treated or prevented?
  • Should you request an MRI if you’re concerned about cerebral SVD?

I will also address what you can do, if you are concerned about cerebral SVD for yourself or an older loved one.

What is cerebral small vessel disease?

Cerebral small vessel disease (SVD) is an umbrella term covering a variety of abnormalities related to small blood vessels in the brain. Because most brain tissue appears white on MRIs, these abnormalities were historically referred to as “white matter changes” or “white matter disease.”

Per this medical review article, specific examples of cerebral SVD include “lacunar infarcts” (which are a type of small stroke), “white matter hyperintensities” (which are a radiological finding), and “cerebral microbleeds” (which means bleeding in the brain from a very small blood vessel).

In many cases, cerebral SVD seems to be a consequence of atherosclerosis affecting the smaller blood vessels that nourish brain tissue. Just as one’s larger blood vessels in the heart or elsewhere can accumulate plaque, inflammation, and chronic damage over the years, so can the smaller blood vessels.

Such chronic damage can lead the small blood vessels in the brain to become blocked (which starves brain cells of oxygen, and which we technically call ischemia), or to leak (which causes bleeding, which we call hemorrhage and can damage nearby brain cells).

When little bits of brain get damaged in these ways, they can change appearance on radiological scans. So when an MRI report says “white matter disease,” this means the radiologist is seeing signs that probably indicate cerebral SVD.

(Note: In this podcast episode, a UCSF brain health expert explains that although cerebral small vessel disease is probably the most common cause of white matter changes in older adults, it’s not the only condition that can cause such changes. )

Such signs of SVD may be described as “mild”, “moderate,” or “severe/extensive,” depending on how widespread they are.

Here is an enlargement of a good image, from the BMJ article “Changes in white matter as determinant of global functional decline in older independent outpatients.”

MRI brain cerebral small vessel ischemic disease
From Inzitari et al, BMJ. 2009 Jul 6;339:b2477. doi: 10.1136/bmj.b2477.

What are the symptoms of cerebral small vessel disease?

The severity of symptoms tends to correspond to whether radiological imaging shows the white matter changes to be mild, moderate, or severe.

Many older adults with cerebral SVD will have no noticeable symptoms. This is sometimes called “silent” SVD.

But many problems have been associated with cerebral SVD, especially when it is moderate or severe. These include:

  • Cognitive impairment. Several studies, such as this one, have found that cerebral SVD is correlated with worse scores on the Mini-Mental State Exam. When problems with thinking skills are associated with SVD, this can be called “vascular cognitive impairment.”
  • Problems with walking and balance. White matter lesions have been repeatedly associated with gait disturbances and mobility difficulties. A 2013 study found that moderate or severe cerebral SVD was associated with a decline in gait and balance function.
  • Strokes. A 2010 meta-analysis concluded that white matter hyperintensities are associated with a more than two-fold increase in the risk of stroke.
  • Depression. White matter changes have been associated with a higher risk of depression in older people, and may represent a contributor to depression that is particular to having first-time depression in later life.
  • Vascular dementia. Signs of cerebral SVD are associated with both having vascular dementia, and eventually developing vascular dementia.
  • Other dementias. Research suggests that cerebral SVD is also associated with an increased risk — or increased severity — of other forms of dementia, such as Alzheimer’s disease. Autopsy studies have confirmed that many older adults with dementia show signs of both Alzheimer’s pathology and cerebral small vessel disease.
  • Transition to disability or death. In a 2009 study of 639 non-disabled older persons (mean age 74), over a three-year follow-up period, 29.5% of participants with severe white matter changes and 15.1% of participants with moderate white matter changes developed disabilities or died. In comparison, only 10.5% of participants with mild white matter changes transitioned to disability or death over three years. The researchers concluded that severity of cerebral SVD is an important risk factor for overall decline in older adults.

So what does this all mean, in terms of symptoms and cerebral SVD? Here’s how I would boil it down:

1.Overall, older adults with any of the problems listed above have a high probability of having cerebral SVD.

2. But, many older adults with cerebral SVD on MRI are asymptomatic, and do not notice any difficulties. This is especially true of aging adults with mild cerebral SVD.

3. Older adults with cerebral SVD are at increased risk of developing the problems above, often within a few years time. This is especially true of people with moderate or severe cerebral SVD.

How is cerebral small vessel disease related to vascular dementia and cerebrovascular accidents?

The term “vascular dementia” means having dementia that is mostly due to having had problems with the blood vessels in the brain.

(For more on the definition of dementia and vascular dementia, see here: Beyond Alzheimer’s: Common Types of Dementia in Aging.)

The brain has some large blood vessels; when a person develops a clot or bleed related to a large blood vessel, this causes a major stroke, also known as a cerebrovascular accident.

It is possible to get dementia after a major stroke. However, in older adults, it’s probably more common to develop vascular dementia due to injuries to the small vessels of the brain. But again, as I explained above: not everyone with signs of cerebral small vessel disease ends up developing cognitive impairment or dementia.

What causes cerebral small vessel disease?

This is a topic of intense research, and the experts in this area tend to really nerd out when discussing it. (Read the scholarly papers listed below to see what I mean.) One reason it’s difficult to give an exact answer is that cerebral SVD is a broad umbrella term that encompasses many different types of problems with the brain’s small blood vessels.

Still, certain risk factors for developing cerebral SVD have been identified. Many overlap with risk factors for stroke. They include:

  • Hypertension
  • Dyslipidemia (e.g. high cholesterol)
  • Atrial fibrillation
  • Cerebral amyloid angiopathy
  • Diabetes
  • Smoking
  • Age
  • Inflammation

There is also evidence that Alzheimer’s disease and cerebral small vessel disease frequently co-exist in older adults, and might interact to accelerate cognitive decline.

How can cerebral small vessel disease be treated or prevented?

Experts are still trying to figure out the answers to this question, and research into the prevention of cerebral SVD is ongoing.

Since worsening of white matter disease is often associated with clinical problems, experts are also trying to determine how we might prevent, or delay, the progression of SVD in older adults.

Generally, experts recommend that clinicians consider treating any underlying risk factors. In most cases, this means detecting and treating any traditional risk factors for stroke.

(For more on identifying and addressing stroke risk factors, see How to Address Cardiovascular Risk Factors for Better Brain Health: 12 Risks to Know & 5 Things to Do.)

To date, studies of hypertension treatment to prevent the progression of white matter changes have shown mixed results. It appears that treating high blood pressure can slow the progression of brain changes in some people. But such treatment may be less effective in people who are older than 80, or who already have severe cerebral SVD.

In other words, your best bet for preventing or slowing down cerebral SVD may be to properly treat high blood pressure and other risk factors before you are 80, or otherwise have significant SVD.

Furthermore, experts don’t yet agree on how low to go, when it comes to optimal blood pressure for an older person with cerebral small vessel disease. (This article explains why this has been difficult to determine.)

For now, to prevent the occurrence or progression of cerebral small vessel disease, it’s reasonable to start by observing the hypertension guidelines considered reasonable for most older adults: treat to a target of systolic blood pressure less than 150mm/Hg.

Whether to treat high blood pressure — and other cardiovascular risk factors — more aggressively should depend on an older person’s particular health circumstances. I explain a step-by-step process you can use (with links to related research) here: 6 Steps to Better High Blood Pressure Treatment for Older Adults.

You can also learn more about the research on CSVD and the effect of treating blood pressure here: The relation between antihypertensive treatment and progression of cerebral small vessel disease.

Should you request an MRI if you’re concerned about cerebral SVD?

Not necessarily. In my opinion, older adults should only get MRIs of the brain if the following two things are true:

  1. They are experiencing worrisome clinical symptoms, and
  2. The results of the MRI are needed to decide on how to treat the person.

For most older adults, an MRI showing signs of cerebral SVD will not, in of itself, change the management of medical problems.

If you have high blood pressure, you should consider treatment. If you are having difficulties with walking or balance, signs of cerebral SVD do not rule out the possibility of other common causes of walking problems, such as medication side-effects, foot pain, neuropathy, and so forth.

What if you’re concerned about memory or thinking problems? Well, you probably will find signs of cerebral SVD on an MRI, just because this is a common finding in all older adults, and it’s especially common in people who are experiencing cognitive changes.

However, the MRI cannot tell you whether the cognitive changes you are noticing are only due to cerebral SVD, versus due to developing Alzheimer’s disease, versus due one of the many other dementia mimics. You will still need to pursue a careful evaluation for cognitive impairment. And no matter what the MRI shows, you will likely need to consider optimizing cardiovascular risk factors.

So in most cases, a brain MRI just to check for cerebral SVD is probably not a good idea.

However, if an MRI is indicated for other reasons, you may find out that an older person has mild, moderate, or severe signs of cerebral SVD. In this case, especially if the cerebral SVD is moderate or severe, you’ll want to consider taking steps to reduce stroke risk, and also to monitor for cognitive changes and increased disability.

What to do if you’re worried about cerebral small vessel disease

If you are worried about cerebral SVD, for yourself or for an older relative, here a few things you can do:

  • Talk to your doctor about your concerns. You may want to discuss your options for optimizing vascular risk factors, including high blood pressure, high cholesterol, high blood sugar, smoking, and others. For more on identifying and addressing stroke risk factors, see How to Address Cardiovascular Risk Factors for Better Brain Health: 12 Risks to Know & 5 Things to Do.
  • Remember that exercise, a healthy diet (such as the Mediterranean diet), good sleep, stress reduction, and many other non-pharmacological approaches can help manage vascular risk factors. Lifestyle approaches are safe and usually benefit your health in lots of ways. Medications to treat high blood pressure and cholesterol should be used judiciously.
  • If an MRI of the brain is clinically indicated — or if one has recently been done — ask the doctor to help you understand how the findings may correspond to any worrisome symptoms you’ve noticed. But if you’ve been worried about cognitive impairment or falls, remember that such problems are usually multi-factorial (i.e. they have multiple causes). So it’s best to make sure the doctors have checked for all other common contributors to thinking problems and/or falls.

If you want to learn still more about cerebral small vessel disease, here are some scholarly articles on the subject:

I also recommend listening to this very informative podcast interview, with Dr. Fanny Elahi of the UCSF Memory and Aging Center: 084 – Interview: Understanding White Matter Changes in the Aging Brain.

Note: We’ve hit 300+ comments on this article! So we’re closing comments for this article. Thank you for your interest!

Note: This article has generated a lot of questions from people under age 60. If that describes you, please read below:

  • Please read the article on “Early Cerebral Small Vessel Disease,” the full article is available for free. This describes SVD found in people aged 40-75. In this study, 2-3% of participants in their 40s showed signs of cerebral SVD.
    • You can check for more recent research on this topic by entering the above article at scholar.google.com, and then click the “Cited by” link to find newer articles that reference this article.
  • I do not know much about cerebral SVD in younger adults; this is not the population that I personally treat nor read much about. (I’m already quite busy trying to keep up with research related to older adults.)
  • As best I can tell, most of what we currently know about health outcomes related to cerebral SVD is based on the studies of older adults. It is not clear to me whether people with cerebral SVD at younger ages should expect similar outcomes. I will not be able to answer most questions related to cerebral SVD in people under age 60.
  • If you are concerned about what caused your MRI findings, or what they might mean for the future, please don’t ask me to tell you, because I don’t have these kinds of answers and I cannot quickly find them online.
    • You should start by talking to your usual doctors, and perhaps a neurologist.
    • If you would like to learn more, consider finding someone specialized in white matter disease in younger adults (e.g. someone doing and publishing research on this topic). Such experts are usually based at an academic medical center. Good luck!
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Comments

  1. My Dad has none of the risk factors but has vascular dementia. Isn’t the real problem caused by the pericytes cells and endothelial cells?

    • Endothelial cells line the inside of blood vessels and pericytes are vascular smooth muscle cells; together they are the building blocks of blood vessels. So yes, you could say that any dysfunction of blood vessels is due to a problem with these cells. But I’m not sure that’s a particularly useful way to think about it.

      Even people without traditional risk factors may have experienced some form of inflammation or irritation to the blood vessels. If you want to better understand why your father has vascular dementia, I would recommend asking his usual doctors to discuss the particular factors that may have contributed.

  2. Dr. Leslie,

    Thank you for this post and for the work you do helping lay people understand brain problems with aging. My friend, who has had a pacemaker and defibrillator for years, was diagnosed with A-fib and aortic stenosis this past March. He is taking medications for high blood pressure and high cholesterol and more recently has been taking Tamsulosin for problems evidently caused by an enlarged prostate. in April had a TAVR. The outcomes look good. I have been concerned about his mental cognition; confusion shows up especially when driving or trying to follow simple directions. I thought he was just showing off when I first saw him use Onstar to get directions back to his home from a nearby restaurant that we frequent but have seen more signs of greater confusion recently.

    In April, prior to the TAVR, I reported some of my concerns about his thinking to his PCP who ordered an MRI. The doctor told us there was no great cause for concern and that things would probably return to normal after the TAVR. Some things have improved but his thinking seems to have declined. He has been under a lot of stress for several years, ever since retiring, experiencing normal decline in his own health but he also was widowed three years ago and nearly lost me due to complications of surgery which left me hospitalized for 6 months in 2016.

    I just read his MRI report and looking up the terms led me to this post. I don’t understand the language. It says
    …overall advanced burden of confluent with additional numerous foci of T2 prolongation seen throughout the periventricular, deep, subcortical white matter bilaterally in the supratentorial and infratentorial white matter….chronic microvascular disease. Overall moderate degree of diffuse cortical volume loss is age appropriate.

    Can you help me understand what is going on with him and what we can do about it?

    I do realize this is lengthy but I hope you are able to receive it all as I’ve found that I learn a lot from the information in other people’s posts and your responses.

    Thank you so much.

  3. I have a small 3 mm aneurysm and 1.1 cm left occi
    pital meningioma

    I also came across this on my MRI report. Which I go back in 2 months for a recheck. I’m 44 female. Low BP, normal sugar, my Cholesterol was slightly elevated at the time. I was heavier since lost 42 lbs.
    No one has given me answers. What does that mean. The year prior it wasn’t there. Is this reversible?

    Several scattered foci of FLAIR signal are noted in the periventricular and subcortical white matter, likely sequela of small vessel ischemic disease. There is no intracranial hemorrhage or major vascular distribution infarct.

    • I am not a neurologist and don’t know much about aneurysms. I did share a little basic information and a link to an article in this comment.

      Your own doctors are the only ones who can really give you answers. If they aren’t doing so, then you must keep asking, as politely and persistently as possible.

      You may also want to ask them about the 12 cardiovascular risk factors that I list in the related articles…your doctors should be able to help you determine whether you are perhaps experiencing chronic inflammation or some other issue that is causing some strain to your small blood vessels. Good luck!

  4. Dr Kernisan,

    I am a 74 year old female who suffered an acute ischemic stroke six years ago which left me with impairment in my left leg. I’d had a history of high blood pressure that was not as well controlled as it should have been. Other than that, I was a very fit, slender person who exercised often and had good cholesterol numbers.
    My MRI report at the time of the stroke states that I have moderate-to-severe chronic small vessel ischemic disease. My blood pressure is now well controlled and I exercise as much as I can within my physical limitations. So far, I believe I have no more mental impairment than an average 74 year old, but I worry about what the future holds, and wonder if there is anything I can do to delay what sounds like inevitable mental impairment.
    I thank you for any advice you can give me.

  5. I am a 63 year old male. I have had 6 pituitary tumor operations with the last being 14 years ago. Two of them were craniotomies and the other 4 were transphenoidal. I have MRIs every couple of years to ensure it doesn’t come back and had one last year when I had an event that the hospital called a Transient Ishemic Attack (TIA). I had some numbness in my left hand, left side gums and teeth, and lost some vision in my left eye. It went away after 20 minutes or so and they had an MRI done and kept me overnight.
    The MRI report said: “Status post left craniotomy. Similar left frontal lobe encephalomalacia. There are additional periventricular and subcortical white matter FLAIR hyperintensities compatible with chronic small vessel ischemic disease. There is no restricted diffusion to suggest acute infarct”.
    I didn’t see a neurologist or a specialist but my doctor put me on chloresterol medication and a baby aspirin because of high HDL. I don’t really know if what my doctor has done is enough or should I see a specialist. I really have no idea what to watch out for or what my future might hold. Any information you can give would be helpful Thanks.

    • There is probably more that can be done, to reduce inflammation and otherwise optimize your cardiovascular health. I address this in the article How to Address Cardiovascular Risk Factors for Better Brain Health: 12 Risks to Know & 5 Things to Do.

      Most “western doctors” are not particularly trained to help people evaluate their nutrition, sleep, stress, and other lifestyle factors. But you could see what a specialist recommends. You could also see if a specialist agrees with the recommendation to take the baby aspirin; it’s usually recommended for people who have a documented high risk of having a cardiovascular event (usually because they already had a heart attack or major stroke). Also a higher HDL is usually considered protective, but perhaps they were concerned about your LDL or total cholesterol. Good luck!

  6. Hi, I am so happy to have found you. greetings from Ireland!

    I currently live with my mom, who is 71. She had an episode of acute confusion last week lasting about 1.5hr, she never regain any memory of it. Her speech was fine and there were no motor symptoms, but she was not orientated to time and kept repeating her actions, e.g. washing her hands 3 times. She did not recognised her usual cream etc. I took her to the hospital and MRI showed moderate generalised atrophy and several small lesions of high signal intensity in the periventricular region = chronic deep white matter ischemia. She gradually regained her memory, but she cant remember any of the 1.5 hr of confusion and she has gaps in her memory from being in hospital. I was told this is unlikely a TIA (which I guess is confirmed not by the MRI), and she could have gotten a seizure or it is the beginning of dementia. I was asked to monitor her cognition. The problem is that we do not live in the same country and she lives alone. My question is: should I be thinking about having her permanently with me now or is she safe to live alone for some time? I know this is not a question you could answer for sure, I am thinking what are the risks of her developing dementia and how fast this could develop? I think cognitively she is fine but I am seeing small behaviours, sometimes apathy, sometimes being a bit inappropriate (which could be part of her personality too!).
    Any thoughts welcome and much appreciated. She is a very bright lady, but there is paternal history of dementia and maternal of CVA/TIAs…

    • Well, her episode does sound worrisome and I can see why you are concerned.

      I would recommend that your family start by getting her a good initial evaluation, to better assess how her cognition and abilities are right now. I recently wrote about what the initial evaluation should cover here: Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check.

      Otherwise, you may need to see how things go over the next 3-6 months. This can be hard if you are in another country, because she very well may not be able (or willing) to report any difficulties to you or any one else. If there is a family member or friend who lives near her, perhaps that person could check on her regularly and keep an eye on things? You want to be monitoring how she manages her daily tasks (driving, shopping, finances, meal prep, etc) and also whether she seems forgetful, is repeating herself, is believing odd things, etc. (I describe the things to take note of in the article on cognitive evaluation)

      I do think that eventually, she’s likely to either need a lot more support to manage at home or she will need to move. But it will be easier to anticipate future needs once you’ve had her more thoroughly evaluated, and once you’ve observed how she’s doing and how things are changing over 6 months or so. Good luck!

  7. Dear Dr. Kernisan, I would like to thank you SO MUCH for this helpful article and for all the time you have taken to reply to comments. Docs need to know their services are appreciated and yours are!

    I am 63 years old and recently had an MRI done in the ED (I was there for tingling in my face and, to my surprise, was having hypertensive urgency) which indicates, “Extensive T2/Flair hyperintensities in the periventricular and subcortical white matter, likely microoangiopathic changes.” While they ruled out an active stroke for me, I am still following up on the comments above. I have heard findings like those in my MRI characterized as “silent strokes”. Would you consider that correct or is it more likely the case that those comments indicate SVD. I am following this up with my PCP and specialists but I wonder if you can help differentiate. Thanks very much!

    • Well, what you are describing sounds like white matter changes. These can be due to very small “silent strokes.” This would be consistent with cerebral small vessel disease.

      There are also “silent strokes” that are a little bigger, meaning the blood vessel affected a larger portion of brain. Doesn’t sound like that’s what they saw in your brain.

      I would encourage you to discuss the findings with your usual doctors, and ask them for advice on what the findings mean in the context of your personal health history. They should also be able to advise you as to how to reduce your risk of progression. Good luck!

  8. Hi,
    I am 48 and I had an MRI scan a couple of years ago and on the notes was printed:
    “Multiple bilateral periventricular and subcortical high signal foci are compatible with small vessel disease.”
    The MRI was because I was admitted for what was thought to be a stroke, but was not fortunately not. But was because of excessive hypertension.
    The notes also say:
    “CT Head – No definite haemorrhage or cortical infarct is identified. White matter change might relate to ischaemia or inflammation.”
    I asked the doctor at the time what that meant and he said that I would probably get dementia. Which I though was a bit insensitive to say so bluntly.

    I’m currently on medication to reduce my blood pressure, but I live in constant fear of dementia.
    In fact I belive I have developed a huge amount of anxiety from it, which probably raises my blood pressure and in turn contributes to risk of further damage…. a vicious cycle I imagine.
    I know that worrying about it doesn’t help and there is probably nothing I can do.

    So my question is, how likely am I to develop dementia and if is this something that manifests itself more strongly as time goes on, being 48 am I likely to be a drooling vegetable by the time I am 60?

    • Well, I can certainly see why your situation would feel very worrisome to you.

      Probably true that worrying doesn’t help however there is likely plenty that you can do. At age 48, you have a pretty good chance of being able to influence your future health by making a variety of changes to improve your cardiovascular health. Which changes to make will depend on your particular circumstances, but many people are able to reduce their risk by addressing diet, exercise, and certain lifestyle factors.

      You can also reduce your risk and improve your wellbeing by addressing your anxiety. Cognitive behavioral therapy is often very effective. It does take time and effort but could really pay off for you. I would also recommend starting a mindfulness practice if you don’t already have one, even 10 minutes daily with an app is likely to be beneficial.

      In terms of your dementia risk: yes you are at risk of vascular dementia, plus everyone who lives long enough (e.g. into their late 80s or 90s) is at significant risk (probably 1 in 3) of developing a neurodegenerative dementia such as Alzheimer’s or Lewy-Body.

      Whether you’re likely to be significantly cognitively impaired by age 60 is hard to say…in general I would say the only people I’ve seen with actual dementia (meaning they can’t manage key daily life tasks) due to vascular causes at that age are the ones who’ve had a major stroke. I suppose it’s possible for it to happen solely due to small vessel disease, but I mainly see that in people who are in their 80s or older.

      Also, I would say that pure small vessel vascular dementia seems much less likely to result in being bedbound and totally disabled…that happens more due to advanced neurodegenerative dementia.

      So, my advice would be: please don’t despair! Yes your brain has experienced some damage but it is not too late to make changes. Please do consider making a big push to address anxiety and mindset. Making the necessary lifestyle changes will be easier after that. Good luck!

  9. For a year and a half I have been seen by a neurologist who said I have parkinsons.
    I wanted another view whether or not I did recently. I had a MRI done. the result was mild chronic vessel ischemic change. Generalized parenchymal volume loss.
    Could I have been told I had parkinsons when I did not.

    • I asked the new neurologist to do a MRI or a CAT SCON. When I first saw the original neurologist I was having tremors in my hands. He had me do q few hand and feet motions and told me I had parkinsons. Then I had 2 times when my hands would not work properly and his P.A. decided this was freezing. She the P.A. consulted with the first neurologist and put me on a higher doze of Carbidiopa . I crochet a lot for charity and I am not convinced it was freezing. I have never had it in my throat or feet. Then it got to where I never saw the first neurologist at all. only the P.A.

      I just had to know. I had to have someone go take pictures. So I contacted a neurologist and ask her to give me her thoughts on the matter. I never mentioned the other doctor s name or his findings. I wanted her to make her own evaluation.

      That is why I have to know do I have Parkinsons . The Doctor who read report said mild csvd change.

      • It sounds like the MRI report does not shed much insight on why you are having your symptoms (which is common). It doesn’t show a major stroke or anything in particular to explain your findings, so your health providers will need to focus on doing a detailed clinical evaluation to determine why you are having your tremor and hand symptoms, and whether or not this might be Parkinson’s. Again, a second opinion from a neurologist or clinic specialized in movement disorders might provide you with a more thorough evaluation.

    • Parkinson’s disease can be challenging to diagnose, and especially to distinguish from other causes of Parkinsonism. There is good information here
      Parkinson’s Diagnosis Questions

      There is no definitive test for Parkinson’s disease and in particular, there is no way for an MRI to rule it in or rule it out. As I explain in the article, MRI signs of cerebral SVD are extremely common in older adults, so it’s not surprising that your MRI shows this.

      Experts generally recommend that people with potential Parkinson’s disease be carefully assessed by a neurologist specialized in movement disorders. If you haven’t seen such a specialist, that might be a good next step to take. Good luck!

  10. please answer my question we just have brain spect scan and MRI for my father and the result of MRI is

    Diffuse brain and chronic small vessel ischemia
    what should i do ?

    • I address what to consider doing in the last section of the article “What to do if you’re worried about cerebral small vessel disease.”

      You will need to discuss with the health providers as it depends on many things, including what symptoms a person is having, why the MRI was ordered, the person’s medical history and other known conditions, etc.

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