To the Editor.
—In the interesting article by Kinkel and colleagues,1 the term Binswanger's disease was used to describe a broad group of patients. Their 23 patients with hypodense white matter areas on computed tomographic (CT) and nuclear magnetic resonance (NMR) scans ranged in clinical symptoms from asymptomatic to severely demented with hydrocephalus. Prior to the availability of CT or NMR, these patients would have been described clinically as either being normal or lacunar state or having multi-infarct dementia, normal pressure hydrocephalus, or subacute arteriosclerotic encephalopathy. The authors, however, used the term Binswanger's disease to describe them all, using the radiologic findings as the single criterion.Elderly individuals are often found to have atrophy on CT scan, but the extent of the atrophy does not predict the loss of intellectual function. Occasionally, normal individuals with abnormal white matter, are identified,2 prompting a neurological consultation to "rule out Binswanger's