White matter changes: the clinical consequences in the aging population

Neuroimaging changes in the cerebral subcortical white matter (WMC) are rec ognized with the highest frequency in elderly subjects, particularly in tho se with vascular risk factors. WMC have been consistently reported to be as sociated with global or selective cognitive deficits, depression, motor and gait impairment. All these deficits are main contributors to disability in the elderly. Moreover, subjects with WMC have an increased risk of cardiov ascular events and death from vascular causes. Functional status in subject s with WMC is variable, from normal to severely (physically or cognitively) disable. The association of WMC with age and with some of the clinical man ifestations of aging suggests that WMC could be one of the age-related proc esses involved in the transition to disability in the elderly. Large cohort s of patients with WMC of different severity and detailed follow-up observa tion may help elucidating this issue. If WMC are shown to have an impact on disability in the aged population, efforts could be made to prevent WMC an d WMC-related motor and cognitive deficits, and to identify measures aimed to halt or slow their progression.