Original Paper Eur Neurol 2001;46:115–120 Relationship between Leuko-Araiosis and Blood Pressure Variability in the Elderly François Puisieux a Pascal Monaca a Dominique Deplanque b Christine Delmaire c Christophe di Pompeo d Christelle Monaca b Didier Leys b Jean-Pierre Pruvo c Philippe Dewailly a a Service de Médecine Interne et Gériatrie, b Service de Neurologie et de Pathologie Neurovasculaire, c Service de Neuroradiologie et d Département d’Évaluation Médicale, Centre Hospitalier Régional Universitaire de Lille, France Received: June 19, 2000 Accepted: May 18, 2001 François Puisieux Service de Médecine Interne et Gériatrie, Hôpital gériatrique les Bateliers 23, rue des Bateliers F–59037 Lille Cedex (France) Tel. +33 3 20 44 46 05, Fax +33 3 20 44 64 87, E-Mail fpuisieux@nordnet.fr ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 2001 S. Karger AG, Basel 0014–3022/01/0463–0115$17.50/0 Accessible online at: www.karger.com/journals/ene Key Words White matter lesions W Blood pressure variability W Hypertension W Ambulatory blood pressure monitoring Abstract Although leuko-araiosis is a common finding on com- puted tomographic (CT) scans of the brain, its pathogene- sis remains uncertain. To investigate the association be- tween blood pressure (BP) disturbances and leuko-araio- sis, we retrospectively reviewed CT scans and 24-hour ambulatory blood pressure monitorings of 79 elderly patients (57 women and 22 men; mean age: 83.3 B 6.4 years). Of the 79 patients, 50 were demented (30 had Alz- heimer’s disease and 18 vascular dementia) and 29 were not demented. The leuko-araiosis score (LA score) was determined by using Rezek’s scale. To evaluate short- term variation of BP, we determined (1) the variability of systolic and diastolic BPs (SBP, DBP; within-subject stan- dard deviation of all readings over a 24-hour period), (2) the coefficient of variability (variability of BP/mean BP) and (3) the maximal variation of BP (difference between the maximum and minimum 24-hour BPs). Higher LA scores were associated with higher SBPs in 24-hour, diur- nal and nocturnal periods, higher maximal variation of SBP, greater variability of SBP during 24-hour, diurnal and nocturnal periods and greater coefficient of variabili- ty of SBP during sleep. Our study suggests that elevations and short-term variations of SBP may contribute to the pathogenesis of white matter lesions in elderly persons. Copyright © 2001 S. Karger AG, Basel Introduction The term ‘leuko-araiosis’ was introduced in 1987 by Hachinski et al. [1] to describe a decreased density of the white matter on computed tomographic (CT) scans of the brain. Leuko-araiosis may be observed in most patients with vascular dementia and is considered as one of the imaging hallmarks of the vascular origin of dementia [2– 4]. Nevertheless, leuko-araiosis is not specific to vascular dementia and may be seen in other types of dementia, especially Alzheimer’s disease [2, 4]. It may also be seen in healthy elderly people and shows a strong positive correla- tion with age [1, 3, 5–7]. Besides age, white matter lesions are associated with other vascular risk factors such as arterial hypertension [3, 8–12] and cardiovascular dis- eases [13]. Such vascular risks are also recognized as risk factors for dementia in the elderly [11, 14]. Since white matter lesions are frequently detected in healthy individuals over 60 years, their significance in the ageing brain and in dementia has been questioned. How- ever, there is evidence suggesting that leuko-araiosis may