Generally early-juveniles have motor skill declines as their first symptoms while late-juveniles show cognitive declines first. The adult form commonly begins after age 16 often with an onset in the 4th or 5th decade of life and presents as a psychiatric disorder or progressive dementia. Adult-onset MLD usually progresses more slowly than the late infantile and juvenile forms, with a protracted course of a decade or more.Palliative care can help with many of the symptoms and usually improves quality of life and longevity.Carriers have low enzyme levels compared to their family population ("normal" levels vary from family to family) but even low enzyme levels are adequate to process the bodys sulfatide. Causes
MLD is directly caused by a deficiency of the enzyme arylsulfatase A (ARSA) and is characterized by enzyme activity in leukocytes that is less than 10% of normal controls. However, assay of the ARSA enzyme activity alone is not sufficient for diagnosis; ARSA pseudodeficiency, which is characterized by enzyme activity that is 5~20% of normal controls does not cause MLD. Without this enzyme, sulfatides build up in many tissues of the body, eventually destroying the myelin sheath of the nervous system. The myelin sheath is a fatty covering that protects nerve fibers. Without it, the nerves in the brain (central nervous system – CNS) and the peripheral nerves (peripheral nervous system – PNS) which control, among other things the muscles related to mobility, cease to function properly.Arylsulfatase A is activated by saposin B (Sap B), a non-enzymatic proteinaceous cofactor.
Cause
The most common causes of visual impairment globally in 2010 were:

Refractive error (42%)
Cataract  (33%)
Glaucoma (2%)
Age-related macular degeneration (1%)
Corneal opacification (1%)
Diabetic retinopathy (1%)
Childhood blindness
Trachoma (1%)
Undetermined (18%)The most common causes of blindness worldwide in 2010 were:

Cataracts (51%)
Glaucoma (8%)
Age-related macular degeneration (5%)
Corneal opacification (4%)
Childhood blindness (4%)
Refractive errors (3%)
Trachoma (3%)
Diabetic retinopathy (1%)
Undetermined (21%)About 90% of people who are visually impaired live in the developing world. Age-related macular degeneration, glaucoma, and diabetic retinopathy are the leading causes of blindness in the developed world.Among working-age adults who are newly blind in England and Wales the most common causes in 2010 were:
Hereditary retinal disorders (20.2%)
Diabetic retinopathy (14.4%)
Optic atrophy (14.1%)
Glaucoma (5.9%)
Congenital abnormalities (5.1%)
Disorders of the visual cortex (4.1%)
Cerebrovascular disease (3.2%)
Degeneration of the macula and posterior pole (3.0%)
Myopia (2.8%)
Corneal disorders (2.6%)
Malignant neoplasms of the brain and nervous system (1.5%)
Retinal detachment (1.4%)

Cataracts
Cataracts are the greying or opacity of the crystalline lens, which can be caused in children by intrauterine infections, metabolic disorders, and genetically transmitted syndromes. Cataracts are the leading cause of child and adult blindness that doubles in prevalence with every ten years after the age of 40. Consequently, today cataracts are more common among adults than in children. That is, people face higher chances of developing cataracts as they age. Nonetheless, cataracts tend to have a greater financial and emotional toll upon children as they must undergo expensive diagnosis, long term rehabilitation, and visual assistance.