White matter lesions in the brain: a question and an answer

One of the readers of my blog asked a very interesting question. I am reproducing her question here. My response to it follows. I hope you shall find it helpful.

Personal Regards,

Nitin Sethi, MD

I am 45 now when I was 25 I was diagnosed as have a pituitary adenoma that caused no active symptoms. Over the years my PCP would follow up with MRI’s and visual field tests. An MRI performed in 03 showed some non specific periventricular high signal white matter changes on the left. Recently in Oct 2010 another MRI was repeated for follow up purposes only. This time it showed several tiny areas of subcortical white matter high signal changes are identified in the right parietal region as well. Pituitary was normal. I am 125 lbs, caucasian femal and I have no neurological symptoms, high blood pressure or diabetes an occasional headache that I get is so mild and I usually pass if off for being tired. My question is what can I do (if anything) to stop these changes from occurring. Does calcium have an effect on this, alcohol consumption (8 to 10 per week) or can cognitive games, etc? Thank you for any input. Best Regards D

braindiseases Dear D,
thank you for writing in. You ask a very good question. Like I explained in my post not all white matter lesions represent MS plaques. The majority of these white matter lesions are what we refer to as ischemic small vessel disease. As the name suggests the pathology lies in the small vessels in the brain. Ischemic white matter disease is more commonly seen as we age. Also patients who have vascular risk factors are more likely to show white matter disease. The common modifiable risk factors are: essential hypertension, diabetes mellitus, dyslipidemia (increased total cholesterol, increased low density lipoprotein and triglycerides and decreased high density lipoprotein), smoking, excessive alcohol intake, obesity and sedentary lifestyle. Some people are hypercoagulable and thus are more prone to strokes and heart disease. Patients who suffer from chronic migraines (especially women) also frequently have “excessive” white matter disease.
Now the million dollar question is whether this white matter disease is harmful to the brain. Does it affect the patient cognitively? There are indeed studies that show that excessive white matter disease may make the person prone to cognitive problems later on in life. This is called vascular dementia. My advise to you would be this:
If you have any of the above vascular risk factors, I would attempt to modify them. Good control of blood pressure is paramount. Earlier a blood pressure of 130/80 or 140/80 was considered acceptable. Nowdays the teaching is “lower the better”. Hence the new guidelines recommend lowering the blood pressure down to 120/70 mm Hg. In the same vein the guidelines with respect to acceptable cholesterol, triglycerides (TG) and low density lipoprotein (LDL) have become more stringent and again the teaching nowdays is “the lower the better”. If you smoke, quit completely as no amount of smoking is good for your heart or the brain. I would advise you to eat a healthy diet rich in vegetables, fruits and nuts. Exercise on a regular basis (cardiovascular exercise such as jogging or brisk walking has been found to be the most beneficial). I usually recommend my patients to take 1-2 tablets of a good multivitamin per day (one that has all the B group of vitamins). Studies have shown that vitamin B12 plays an important role in cognition and so I usually recommend it to most of my elderly patients especially those who are vegetarians and have a marginal diet. I find my patients frequently deficient in Vitamin D (vitamin D is made in the skin from sunlight and so caucasians living in the temperate areas are frequently vitamin D deficient) and so I supplement it. The amount of vitamin D needed on a daily basis varies according to your sex and age and you should consult your primary care physician to determine how much you should take. I usually give my patients around 400 international units of vitamin D per day.
I am a big believer in cognitive games (the fancy word for this now is Neurobics). You can read more about these in my neurobic post here or on my website http://braindiseases.info.
I hope I have addressed your concerns adequately.

Personal Regards,
Nitin Sethi, MD

More neurobics anyone?

Came with a few more neurobics which can be fun and at the same time healthy for the brain. Have fun with neurobics everyone!

1) run or walk backwards (be careful not to fall though please). I tried this myself. It is amazing how your brain is more active and conscious about the task of walking or runing backwards. Compare this with when you walk or run normally forwards, the task is nearly subconsciously attempted by the brain without even thinking about it.

2) use your left hand (if you are right handed) to answer your phone. If you use a mobile phone this has the added advantage of reducing the radiofrequecy exposure to the right side of the brain as nowdays there are some reports commenting on the increased risk of brain tumors in heavy mobile phone users.

3) learn a new language (I recommend this one).

4) hear a song and commit it to your memory. Now write down the lyrics on a piece of paper.

5)commit more things to your own memory rather than the memory of your palm-pilot. Buy a palm pilot with less memory and use it less too!!!

Personal Regards,

Nitin Sethi, MD



Another interesting article in the Wall Street Journal by Melinda Beck where she talks about neurobics or rather mental exercises which may have a role in preventing or rather delaying the onset of neurodegenerative diseases like Alzheimer’s dementia.

As she rightly points out in her article, the etiology of Alzheimer’s dementia is thought to involve genetic and environmental factors and it is unlikely that mental exercises (neurobics) shall prevent the onset of Alzheimer’s dementia. But research and studies have shown that people who have a good neuronal reserve (higher intellect) seem to fair better when they get stricken by Alzheimer’s dementia as compared to people who are less educated and I guess with lower neuronal reserve.

So I would advise everyone to indulge in neurobics everyday. It is easy to do, has no side-effects and possible benefits.

Some neurobics I recommend:

1) If you are right handed, try brushing with your left hand (and vice versa if you are left handed).

2) If you are right handed, try eating with your left hand (and vice versa if you are left handed).

3) try writing with your non-dominant hand (now this is hard and painfully slow at times)

4) do crossword puzzles, number games

5) learn to play chess

6) learn to play a musical instrument (drums are great since they require a lot of hand coordination)

7) avoid using palm pilots and hand held devices. Commit more things to your memory. You do not need a palm pilot to remind you what you going to do during the day.

8)  Read books and newspapers instead of watching TV all the time. Remember when you are watching TV, you are doing nothing. You are just a passive spectator. When you read, you use your brain.

9) avoid using calculators. Try to balance your cheque books without the aid of calculators.

10) be Sherlock Holmes for a day. Try to memorize all the number plates you see while driving to work. (As he would say “elimentary my dear Watson” )

11) Exercise everyday. Regular exercise like walking or running is good for the brain.

12) Sleep well at night for at least 8 hours.

13) Drink alcohol in moderation.

14) learn a new skill: learn how to swim, play golf, play tennis etc.

Happy neurobics everyone.

Personal Regards,

Nitin Sethi, MD