http://tan.sagepub.com/content/5/5/267.abstract?etoc=
Abstract
White matter dementia (WMD) is a syndrome
introduced in 1988 to highlight the potential of cerebral white matter disorders to produce cognitive loss of sufficient severity to qualify as dementia. Neurologists have long understood that such a syndrome can occur, but the dominance of gray matter as the
locus of higher function has strongly directed neurobehavioral inquiry to the cerebral cortex while white matter has
received less attention. Contemporary neuroimaging has been crucial in enabling the recognition of white matter abnormalities in a host of disorders, and the correlation of these changes with cognitive performance. Comprising about half the brain, white
matter is prominently or exclusively involved in well over 100 disorders,in each of which white matter dysfunction can
potentially cause or contribute to dementia. Neuropsychological findings from ten categories of white matter disorder lead to a
convergence of findings that document remarkable neurobehavioral commonality among the dementias produced. More recently, the
syndrome of mild cognitive dysfunction (MCD) has been introduced to expand the concept of WMD by proposing a precursor
syndrome related to early white matter neuropathology. WMD and MCD inform the understanding of how white matter contributes to
normal and abnormal cognition, and the specific neuroanatomic focus of these syndromes may enhance the diagnosis and treatment
of many disabling disorders that do not primarily implicate the cerebral cortex. Forming essential connections within widely
distributed neural networks, white matter is critical for rapid and efficient information transfer that complements the
information processing of gray matter. As neuroimaging continues to advance, further information on white matter structure can be
expected, and behavioral neurology will play a central role in elucidating the functional significance of these emerging data. By
emphasizing the contribution of myelinated systems to higher function, the study of white matter and cognition represents
investigation of the basic neuroscience of human behavior.
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