Neurological abnormalities predict disability: the LADIS (Leukoaraiosis And DISability) study
Neurological abnormalities predict disability: the LADIS (Leukoaraiosis And DISability) study
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DOI：
10.1007/s00415-014-7332-9
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发表时间：
2014-06-01
影响因子：
6
通讯作者：
Pantoni, Leonardo
中科院分区：
文献类型：
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作者：
Poggesi, Anna;Gouw, Alida;Pantoni, Leonardo
旨在研究神经系统异常和磁共振成像 (MRI) 病变在预测一组最初独立生活的老年受试者的整体功能衰退中的作用。脑白质疏松和残疾 (LADIS) 研究涉及 11 个欧洲中心，主要旨在评估与年龄相关的白质变化 (ARWMC)，作为独立老年受试者向残疾转变（根据工具性日常生活活动量表）或死亡的独立预测因素，并进行为期 3 年的随访。在基线时，进行标准化神经学检查。 MRI 评估包括与年龄相关的白质变化 (ARWMC) 分级（根据 Fazekas 分级为轻度、中度、重度）、腔隙性和非腔隙性梗塞计数以及整体萎缩评级。在 633 名（纳入的 639 名）有随访信息的患者中（平均年龄 74.1 +/- A 5.0 岁，45% 为男性），327 名（51.7%）在初次就诊时出现千分之1 神经系统异常，242 名（38%）达到了主要研究结果。 Cox 回归分析，调整 MRI 特征和功能衰退的其他决定因素，表明任何神经系统异常的基线存在独立预测向残疾或死亡的转变 [HR (95% CI) 1.53 (1.01-2.34)]。随着异常数量的增加，危险也随之增加。在 MRI 病变中，只有严重级别的 ARWMC 可以独立预测残疾或死亡 [HR (95% CI) 2.18 (1.37-3.48)]。在我们的队列中，神经系统检查异常的存在和数量预测了整体功能下降，与衰老大脑典型的 MRI 病变和老年人残疾的其他决定因素无关。系统地检查老年患者的神经系统检查异常对于识别那些有功能衰退风险的患者可能具有成本效益。
To investigate the role of neurological abnormalities and magnetic resonance imaging (MRI) lesions in predicting global functional decline in a cohort of initially independent-living elderly subjects. The Leukoaraiosis And DISability (LADIS) Study, involving 11 European centres, was primarily aimed at evaluating age-related white matter changes (ARWMC) as an independent predictor of the transition to disability (according to Instrumental Activities of Daily Living scale) or death in independent elderly subjects that were followed up for 3 years. At baseline, a standardized neurological examination was performed. MRI assessment included age-related white matter changes (ARWMC) grading (mild, moderate, severe according to the Fazekas' scale), count of lacunar and non-lacunar infarcts, and global atrophy rating. Of the 633 (out of the 639 enrolled) patients with follow-up information (mean age 74.1 +/- A 5.0 years, 45 % males), 327 (51.7 %) presented at the initial visit with a parts per thousand yen1 neurological abnormality and 242 (38 %) reached the main study outcome. Cox regression analyses, adjusting for MRI features and other determinants of functional decline, showed that the baseline presence of any neurological abnormality independently predicted transition to disability or death [HR (95 % CI) 1.53 (1.01-2.34)]. The hazard increased with increasing number of abnormalities. Among MRI lesions, only ARWMC of severe grade independently predicted disability or death [HR (95 % CI) 2.18 (1.37-3.48)]. In our cohort, presence and number of neurological examination abnormalities predicted global functional decline independent of MRI lesions typical of the aging brain and other determinants of disability in the elderly. Systematically checking for neurological examination abnormalities in older patients may be cost-effective in identifying those at risk of functional decline.