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
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
复制标题
DOI：
10.1136/jnnp.2008.154633
复制
发表时间：
2009-06-01
影响因子：
11
通讯作者：
Hennerici, M. G.
中科院分区：
文献类型：
--
作者：
Blahak, C.;Baezner, H.;Hennerici, M. G.
背景：全球年龄相关性白质改变(ARWMC)与进行性步态障碍和跌倒有关，假设是由于控制平衡、姿势和运动的皮质下回路中断所致。方法：利用脑白质疏松和残疾(LADIS)研究的横断面数据，分析ARWMC在大量报告跌倒的老年非残疾人群中的位置。结果：全球ARWMC的严重程度与纳入研究前一年的跌倒史显著相关(根据Fazekas分级，轻度ARWMC组22.2%，中度ARWMC组31.6%，重度ARWMC组37.3%；p=0.002)。分析ARWMC的解剖分布，采用半定量的Schelten评分，在多因素分析中，脑室周围(P=0.006)和额部深(P=0.033)ARWMC与跌倒独立相关。此外，Logistic回归分析发现，额叶深部(p=0.003)ARWMC与平衡障碍显著相关，但与基底节和幕下高信号无关。结论：额叶和脑室周围ARWMC与跌倒的关联支持了额叶皮质下运动神经回路中断导致平衡障碍的假设，从而增加了ARWMC跌倒的风险。
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.