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
- C Blahak1,
- H Baezner1,
- L Pantoni2,
- A Poggesi2,
- H Chabriat3,
- T Erkinjuntti4,
- F Fazekas5,
- J M Ferro6,
- P Langhorne7,
- J O’Brien8,
- M C Visser9,
- L-O Wahlund10,
- G Waldemar11,
- A Wallin12,
- D Inzitari2,
- M G Hennerici1
- 1Department of Neurology, University of Heidelberg, Klinikum Mannheim, Mannheim, Germany
- 2Department of Neurological and Psychiatric Sciences, University of Florence, Italy
- 3Department of Neurology, Hôpital Lariboisiere, Paris, France
- 4Memory Research Unit, Department of Clinical Neurosciences, Helsinki University, Helsinki, Finland
- 5Department of Neurology and MRI Institute, Medical University Graz, Austria
- 6Serviço de Neurologia, Centro de Estudos Egas Moniz, Hospital de Santa Maria Lisboa, Portugal
- 7Academic Department for Geriatric Medicine, Glasgow Royal Infirmary, Glasgow, UK
- 8Institute for Ageing and Health, University of Newcastle, Newcastle upon Tyne, UK
- 9Departments of Radiology and Neurology, VU Medical Centre, Amsterdam, The Netherlands
- 10Karolinska Institute, Department of Clinical Neuroscience and Family Medicine, Huddinge, University Hospital, Huddinge, Sweden
- 11Memory Disorders Research Unit, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
- 12Institute of Clinical Neuroscience, Goteborg University, Goteborg, Sweden
- 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
- Received 7 July 2008
- Revised 6 November 2008
- Accepted 3 December 2008
- Published Online First 9 February 2009
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.
Footnotes
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‣ A list of participating centres and personnel is published online only at http://jnnp.bmj.com/content/vol80/issue6
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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.
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Competing interests: None.
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Ethics approval: The study was approved by the local ethics committee at the University of Heidelberg.
