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Deep frontal and periventricular age related white matter changes but not basal ganglia and infratentorial hyperintensities are associated with falls: cross sectional results from the LADIS study
  1. C Blahak1,
  2. H Baezner1,
  3. L Pantoni2,
  4. A Poggesi2,
  5. H Chabriat3,
  6. T Erkinjuntti4,
  7. F Fazekas5,
  8. J M Ferro6,
  9. P Langhorne7,
  10. J O’Brien8,
  11. M C Visser9,
  12. L-O Wahlund10,
  13. G Waldemar11,
  14. A Wallin12,
  15. D Inzitari2,
  16. M G Hennerici1
  1. 1
    Department of Neurology, University of Heidelberg, Klinikum Mannheim, Mannheim, Germany
  2. 2
    Department of Neurological and Psychiatric Sciences, University of Florence, Italy
  3. 3
    Department of Neurology, Hôpital Lariboisiere, Paris, France
  4. 4
    Memory Research Unit, Department of Clinical Neurosciences, Helsinki University, Helsinki, Finland
  5. 5
    Department of Neurology and MRI Institute, Medical University Graz, Austria
  6. 6
    Serviço de Neurologia, Centro de Estudos Egas Moniz, Hospital de Santa Maria Lisboa, Portugal
  7. 7
    Academic Department for Geriatric Medicine, Glasgow Royal Infirmary, Glasgow, UK
  8. 8
    Institute for Ageing and Health, University of Newcastle, Newcastle upon Tyne, UK
  9. 9
    Departments of Radiology and Neurology, VU Medical Centre, Amsterdam, The Netherlands
  10. 10
    Karolinska Institute, Department of Clinical Neuroscience and Family Medicine, Huddinge, University Hospital, Huddinge, Sweden
  11. 11
    Memory Disorders Research Unit, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
  12. 12
    Institute of Clinical Neuroscience, Goteborg University, Goteborg, Sweden
  1. Dr C Blahak, Department of Neurology, Universitätsklinikum Mannheim, Theodor-Kutzer Ufer 1-3, D-68167 Mannheim, Germany; c.blahak{at}neuro.ma.uni-heidelberg.de

Abstract

Background: Global age related white matter changes (ARWMC) are associated with progressive gait disturbances and falls, hypothesised to result from interruptions of cortico-subcortical circuits controlling balance, posture and locomotion.

Methods: The location of ARWMC in a large cohort of elderly non-disabled individuals with reported falls was analysed, using the cross sectional data of the Leukoaraiosis and Disability (LADIS) study. Detailed anatomical distributions of ARWMC assessed by MRI studies were analysed with respect to falls and balance performance.

Results: The severity of global ARWMC was significantly associated with a history of falls in the year prior to study inclusion (22.2% in the mild, 31.6% in the moderate and 37.3% in the severe ARWMC group according to the Fazekas scale; p = 0.002). Analysing the anatomical distribution of ARWMC, using the semiquantitative Scheltens scale, in multivariate analysis, periventricular (p = 0.006) and frontal deep (p = 0.033) ARWMC were independently associated with falls. Furthermore, logistic regression identified frontal deep (p = 0.003) ARWMC, but not basal ganglia and infratentorial hyperintensities, as significantly associated with balance disturbances.

Conclusion: The association of frontal and periventricular ARWMC with falls supports the hypothesis that interruption of frontal subcortical motor circuits lead to balance disturbances and hence to an increased risk for falls in ARWMC.

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Footnotes

  • ▸ A list of participating centres and personnel is published online only at http://jnnp.bmj.com/content/vol80/issue6

  • Funding: The LADIS Study is supported by the European Union within the Vth European Framework Programme “Quality of Life and Management of Living Resources” (1998–2002), contract No QLRT-2000-00446 as a concerted action. The sponsor played no role in the design, methods, subject recruitment, data collection, analysis or preparation of the paper.

  • Competing interests: None.

  • Ethics approval: The study was approved by the local ethics committee at the University of Heidelberg.

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