Hello dear Greetings Regarding your wife MRI result that yield mild to moderate chronic microvascular ischaemic changes with mild ventriculomegaly I am suggesting that she is gradually developing the following differential diagnosis Multiple sclerosis Disseminated encephalomyelitis Encephalopathy Alzheimers disease Picks disease Lewy body dementia In view of this please do the following test CT SCAN LUMBER PUNCTURE MRI SERUM ELECTROLYTES Meanwhile please see a neurologist specialist with the results and for further clinical assessment Councelling and adequate drug prescription I hope this helps Regards