Bilateral extensive white matter changes (a.k.a. leukoaraiosis) are seen in various conditions:

• Binswanger disease
• CADASIL
• Alzheimer's disease
• multiple sclerosis (MS)
• progressive multifocal leukoencephalopathy (PML)
• normal elderly individuals

Clinical presentation of the patient, including age, presence or absence of hypertension usually helps in differentiating most of these causes.