Understanding White Matter Disease: Symptoms, Causes, and Treatments

Written by Stephanie Watson, Kelli Miller
Medically Reviewed by Shruthi N, MD on January 09, 2025
5 min read

White matter disease is the wearing away of tissue in the largest and deepest part of your brain. The loss of white matter function has a number of causes, including aging. This tissue contains millions of nerve fibers, or axons, that connect other parts of the brain and spinal cord and signal your nerves to talk to one another. A fatty material called myelin protects the fibers and gives white matter its color.

This type of brain tissue helps you think fast and walk straight and keeps you from falling. When it becomes diseased, the myelin breaks down. The signals that help you do these things can't get through. Your body stops working like it should, much like a kink in a garden hose makes the water that comes out go awry.

White matter disease happens in older or elderly people. There are ways to prevent or even reverse this condition, but you need to start now.

Leukoaraiosis is another name your doctor might use to describe white matter disease.

Many diseases, injuries, and toxins can cause changes in your white matter. Doctors point to the same blood vessel problems that lead to heart trouble or strokes:

It may be worse for women. You may also be more likely to get it if you have:

  • Diabetes
  • High cholesterol
  • Parkinson's disease
  • History of stroke

Genetics may also play a role.

White matter helps you with problem-solving and focusing. It also plays an important role in mood, walking, and balance. So when something's wrong with it, you might notice:

  • Trouble learning or remembering new things
  • A hard time with problem-solving
  • Slowed thinking
  • Leaking urine
  • Depression
  • Problems walking
  • Balance issues and more falls

White matter disease is different from Alzheimer's disease, which affects the brain's gray matter. If you're having memory problems or a loved one is, a doctor will need to run tests to make a diagnosis.

Early signs of white matter disease

The first signs of white matter loss may be mild and can include:

  • Trouble moving
  • Falling
  • Stiffness
  • Uncontrollable laughter or crying

Sometimes white matter disease doesn't show any symptoms in the early stages. It may not be discovered until your doctor orders an MRI test for another reason.

The two types of brain tissues are white matter and grey matter. Your brain is about 40% grey matter and 60% white matter. Grey matter is made up of nerve cell bodies and extensions called dendrites. Nerve impulses travel down the dendrites from one neuron to another, allowing neurons to communicate with each other. You can think, learn, and speak thanks to grey matter.

White matter is made up of nerve fibers. It transmits nerve signals to enable communication between grey matter in different areas of your brain.

Advances in medical imaging have made white matter disease easier to spot. An MRI test, which takes pictures of the inside of your brain, can show any damage. Changes in the white matter will show up super-bright white (your doctor may call this "hyperintense") on an MRI scan. You may need more tests to rule out other causes.

There isn't a specific treatment. The goal is to treat the cause of the damage and stop the disease from getting worse. Your doctor may prescribe medicines to lower your blood pressure or cholesterol. If you smoke, your doctor has tips and tools to help you quit.

Treatments are available to manage specific white matter disease symptoms.

Urinary incontinence

Techniques like bladder training and scheduled bathroom trips can teach you how to hold off the urge to go. Cutting back on fluids will reduce the number of times you have to pee each day. Pelvic floor exercises, or Kegels, strengthen the muscles that help you control urine flow. And medicines like alpha-blockers and anticholinergics relax your bladder muscle so you don't have to pee as urgently.

Balance and walking problems

A physical therapist can teach you exercises to strengthen the muscles you use to walk and stay balanced. You can also learn techniques to prevent falls.

Depression

Depression both causes and is caused by white matter damage. Antidepressant medications and talk therapy are treatments for depression that's related to white matter disease.

Age-related white matter disease is progressive, meaning it can get worse. But you can take steps to stop it from spreading. Scientists think you might even be able to repair the damage if you catch it early and take the following preventative steps:

  • Keep your blood pressure and blood sugar in check.
  • To keep your heart healthy, follow a low-fat, low-salt diet and get about two and a half hours of moderate-intensity exercise each week.
  • Manage diabetes if you have it.
  • Keep your cholesterol in check.
  • If you smoke, stop now.

Your outlook depends on what type of white matter disease you have and how severe it is. The disease tends to be worse when it starts during infancy or early childhood. People with more severe forms may only live for a few months or years. Those with less severe forms can have a normal life expectancy.

White matter disease damages the tissue that connects parts of your brain and spinal cord that help your nerves talk to one another. High blood pressure, blood vessel inflammation, and smoking are some causes of this disease. Treatment focuses on the causes and symptoms. Managing conditions like high blood pressure, high cholesterol, and diabetes can slow or stop the progression of white matter disease.

What are the first signs of white matter disease?

The earliest signs of white matter disease may be mild difficulty walking, stiffness, and falling.

Should I be worried about white matter disease?

You might be at a risk of white matter disease if you have high blood pressure, high cholesterol, or diabetes and if you smoke. Managing these risks can reduce your risk of this condition.

What are the four stages of white matter disease?

Researchers have divided white matter diseases into stages 1 through 4. The higher the stage, the more damage to white matter has occurred, and the more problems with brain signaling a person will have.

Can you live a long life with white matter disease?

The lifespan differs based on the severity of white matter disease. When the disease starts during infancy or childhood, it's usually more severe and life expectancy is shorter.