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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. Christian Blahak (c.blahak{at}neuro.ma.uni-heidelberg.de)
  1. Department of Neurology, Universitaetsklinikum Mannheim, University of Heidelberg, Mannheim, Germany
    1. Hansjoerg Baezner
    1. Department of Neurology, Universitaetsklinikum Mannheim, University of Heidelberg, Mannheim, Germany
      1. Leonardo Pantoni
      1. Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
        1. Anna Poggesi
        1. Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
          1. Hugues Chabriat
          1. Department of Neurology, Hôpital Lariboisière, Paris, France
            1. Timo Erkinjuntti
            1. Memory Research Unit, Department of Clinical Neurosciences, Helsinki University, Helsinki, Finland
              1. Franz Fazekas
              1. Department of Neurology and MRI Institute, Karl Franzens University Graz, Graz, Austria
                1. José M Ferro
                1. Neurology Department, Centro de Estudos Egas Moniz, Santa Maria Hospital, Lisbon, Portugal
                  1. Peter Langhorne
                  1. Academic Department for Geriatric Medicine, Glasgow Royal Infirmary, Glasgow, Scotland, United Kingdom
                    1. John O'Brien
                    1. Institute for Ageing and Health, University of Newcastle, Newcastle-upon-Tyne, United Kingdom
                      1. Marieke C Visser
                      1. Department of Neurology, VU Medical Centre, Amsterdam, Netherlands
                        1. Lars-Olof Wahlund
                        1. Karolinska Institute, Department of Clinical Neuroscience and Family Medicine, Huddinge University, Sweden
                          1. Gunhild Waldemar
                          1. Memory Disorders Research Unit, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
                            1. Anders Wallin
                            1. Institute of Clinical Neuroscience, Göteborg University, Göteborg, Sweden
                              1. Domenico Inzitari
                              1. Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
                                1. Michael G Hennerici
                                1. Department of Neurology, Universitaetsklinikum Mannheim, University of Heidelberg, Mannheim, Germany

                                  Abstract

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

                                  Methods: We analyzed the location of ARWMC in a large cohort of elderly non-disabled individuals with reported falls, 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 the 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=.002). Analysing the anatomical distribution of ARWMC, using the semi-quantitative Scheltens scale, in multivariate analysis periventricular (P=.006) and frontal deep (P=.033) ARWMC were independently associated with falls. Furthermore, logistic regression identified frontal deep (P=.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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