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Hidekazu Tomimoto, MD; Ichiro Akiguchi, MD; Ryo Ohtani, MD; Hideo Yagi, MD; Masutaro Kanda, MD; Hiroshi Shibasaki, MD; Yasumasa Yamamoto, MD

Arch Neurol. 2001;58:1620-1625.

Background  Hypercoagulability is observed in vascular dementia, including Binswanger disease. However, the correlation between hypercoagulability, leukoaraiosis, and dementia remains unclear.

Objective  To examine how activation of the coagulation fibrinolysis correlates with leukoaraiosis and dementia.

Patients and Methods  Thrombin-antithrombin complex (TAT), prothrombin fragment_{1 + 2} (F_{1 + 2}) and cross-linked D-dimer (XDP) were measured consecutively in 18 subjects without dementia and with leukoaraiosis, and in 29 subjects with subcortical vascular dementia and severe leukoaraiosis (Binswanger disease) at either stable or deteriorating stages. They were compared with 19 patients with old lacunar infarctions and 24 patients with other neurological diseases. We also examined the indices of cognitive impairment and brain atrophy. In each group, the ventricular area–cranial space area ratio was measured by an image analyzer.

Results  Patients with Binswanger disease who were exclusively at deteriorating stages showed increased TAT and XDP levels and an increased ventricular area–cranial space area ratio, as compared with the patients with other neurological diseases (P<.001). The index of cognitive impairment in patients at a deteriorating stage showed a decreasing trend vs that of patients in the stable stage. Among the variables that were significantly associated with a hypercoagulable condition (ie, age, scores on Mini-Mental State Examination or the Hasegawa Dementia Rating Scale, Revised [MMSE/HDRS], white matter lesions, ventricular area–cranial space area ratio, and C-reactive protein), age (odds ratio [OR], 2.82) and MMSE/HDSR scores (OR, 0.43) survived as predictors for coagulation activation, and C-reactive protein survived for fibrinolysis activation (OR, 4.63) in multivariate analysis.

Conclusion  Hypercoagulability in a subgroup of patients with Binswanger disease and with more severe cognitive impairment and brain atrophy does not support a triggering role for a coagulation-fibrinolysis system, although it may contribute to worsening of neurological deficits.

From the Department of Neurology, Faculty of Medicine, Kyoto University, Kyoto, Japan (Drs Tomimoto, Akiguchi, Ohtani, Yagi, Kanda, and Shibasaki), and the Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto (Dr Yamamoto).

Corresponding author: Hidekazu Tomimoto, MD, Department of Neurology, Faculty of Medicine, Kyoto University, Kyoto 606-8507, Japan (e-mail: tomimoto{at}isola.kuhp.kyoto-u.ac.jp).

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