Cerebral small vessel disease
Cerebral small vessel disease is a common condition affecting the brain’s small blood vessels, particularly in older adults, though it is not a normal part of ageing and can occur in younger people. It often causes no symptoms and is frequently discovered incidentally on brain scans. Small vessel disease is a major cause of stroke and dementia and can lead to gradual problems with thinking, memory, balance, and walking. Finding it on a scan does not necessarily mean a person has had a stroke. Although it often prompts little follow-up, early recognition offers an opportunity to reduce future risk through managing vascular risk factors and maintaining a healthy lifestyle.
Although cerebral small vessel disease is very common, many people have never heard of it. It affects most older adults, but it should not be considered a normal part of ageing. It can also occur in younger people. It’s quite possible to have small vessel disease without knowing it. In many cases it causes no obvious symptoms and goes undetected. However, when it is identified, it’s important to think about ways to reduce the risk of future problems. What is small vessel disease? Small vessel disease is the most common type of cerebrovascular disease, meaning disease of the brain’s blood vessels. It affects the brain’s small blood vessels, leading to changes such as white matter damage, which can be seen on brain scans. High blood pressure and diabetes are common causes, but there are several other possible causes. What problems can it cause? Small vessel disease is responsible for around one in four strokes, but stroke is only part of the picture. It is also the second most common cause of dementia. Many more people with small vessel disease gradually develop problems over time, such as difficulties with thinking, memory, balance, or walking. What is small vessel disease not? Although small vessel disease can cause strokes, finding signs of it on a brain scan does not automatically mean that someone has had a stroke. A stroke is a clinical event that causes a sudden loss of function, such as weakness or difficulty speaking. Incorrectly labelling someone as having had a stroke can lead to unnecessary problems, for example with driving, insurance, or anxiety about their health.
How is small vessel disease identified? Small vessel disease may be discovered when someone has a stroke or develops dementia. More often, it is found incidentally on a brain scan done for another reason. For example, brain scans performed for headaches usually don’t reveal a serious cause. However, they often show incidental findings, and small vessel disease is the most common of these, particularly in older adults. What happens after small vessel disease is found? Often, very little happens. Unlike findings such as a cyst or a benign tumour, which usually lead to specialist referral and follow-up scans, small vessel disease seen on a brain scan frequently does not prompt further action — even when the changes are quite marked. This is unfortunate, as it may mean missing an opportunity to reduce the risk of future problems. What should be done? At present, healthcare services tend to focus on treating the complications of small vessel disease, such as stroke or dementia. There is a need to do more to support prevention and early management. It’s also important to understand the type of small vessel disease. Most cases are related to vascular risk factors like high blood pressure, but other causes — such as cerebral amyloid angiopathy or certain genetic conditions — may need different approaches. What can you do yourself? Maintaining a healthy lifestyle is important. This includes: keeping a healthy weight exercising regularly eating a balanced diet stopping smoking, if you smoke It’s also important to ensure that treatable conditions such as high blood pressure are identified and managed, and that diabetes and high cholesterol are well controlled.