Leukoaraiosis (LA) is the term applied to the frequent finding in older persons of white matter changes on neuroimaging studies that take the form of low densities on CT and hyperintensities on T2-weighted MRI scans. Much controversy has swirled around both the origin and the significance of these findings. Many neurologically normal older people, for example, have apparently incidental white matter changes on CT or MRI. Neuropathologic studies of these changes have suggested that they are ischemic in origin, and that when they are more severe white matter infarction can be seen. Regarding clinical significance, it appears that white matter infarcts, even a single one, may have neurobehavioral sequelae if careful evaluation is undertaken, and that multiple infarcts clearly can lead to dementia. Whether white matter ischemia alone has neurobehavioral effects remains unclear, although evidence is accruing that these effects may be detectable when a certain threshold of involvement is reached. On this basis, it has been suggested that LA lies on the same continuum as Binswanger's disease.

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