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Gagliardo A, Grippo A, Di Stefano V, Carrai R, Scarpino M, Martini M, Falsini C, Rimmaudo G, Brighina F. Spatial and Temporal Gait Characteristics in Patients Admitted to a Neuro-Rehabilitation Department with Age-Related White Matter Changes: A Gait Analysis and Clinical Study. Neurol Int 2023; 15:708-724. [PMID: 37368328 DOI: 10.3390/neurolint15020044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/01/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Patients with age-related white matter changes (ARWMC) frequently present a gait disorder, depression and cognitive impairment. Our aims are to define which alterations in the gait parameters are associated with motor or neuro-psychological impairment and to assess the role of motor, mood or cognitive dysfunction in explaining the variance of the gait parameters. METHODS Patients with gait disorders admitted to a Neuro-rehabilitation Department, affected by vascular leukoencephalopathy who had ARWMC confirmed by a brain MRI, were consecutively enrolled, classified by a neuroradiological scale (Fazekas 1987) and compared to healthy controls. We excluded subjects unable to walk independently, subjects with hydrocephalus or severe aphasia, with orthopaedic and other neurological pathologies conditioning the walking pattern. Patients and controls were assessed by clinical and functional scales (Mini Mental State Examination, Geriatric Depression Scale, Nevitt Motor Performance Scale, Berg Balance Scale, Functional Independence Measure), and computerised gait analysis was performed to assess the spatial and temporal gait parameters in a cross-sectional study. RESULTS We recruited 76 patients (48 males, aged 78.3 ± 6.2 years) and 14 controls (6 males, aged 75.8 ± 5 years). In the multiple regression analysis, the gait parameter with overall best model summary values, associated with the ARWMC severity, was the stride length even after correction for age, sex, weight and height (R2 = 0.327). The motor performances justified at least in part of the gait disorder (R2 change = 0.220), but the mood state accounted independently for gait alterations (R2 change = 0.039). The increase in ARWMC severity, the reduction of motor performance and a depressed mood state were associated with a reduction of stride length (R = 0.766, R2 = 0.587), reduction of gait speed (R2 = 0.573) and an increase in double support time (R2 = 0.421). CONCLUSION The gait disorders in patients with ARWMC are related to motor impairment, but the presence of depression is an independent factor for determining gait alterations and functional status. These data pave the way for longitudinal studies, including gait parameters, to quantitatively assess gait changes after treatment or to monitor the natural progression of the gait disorders.
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Affiliation(s)
- Andrea Gagliardo
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- Clinical Neurophysiology Unit, "Clinical Course", 90143 Palermo, Italy
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e degli Organi di Senso, AOU Careggi, 50134 Firenze, Italy
| | - Vincenzo Di Stefano
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
| | - Riccardo Carrai
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e degli Organi di Senso, AOU Careggi, 50134 Firenze, Italy
| | - Maenia Scarpino
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e degli Organi di Senso, AOU Careggi, 50134 Firenze, Italy
| | - Monica Martini
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
| | | | - Giulia Rimmaudo
- Clinical Neurophysiology Unit, "Clinical Course", 90143 Palermo, Italy
| | - Filippo Brighina
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
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Blumen HM, Jayakody O, Verghese J. Gait in cerebral small vessel disease, pre-dementia, and dementia: A systematic review. Int J Stroke 2023; 18:53-61. [PMID: 35797006 PMCID: PMC9841467 DOI: 10.1177/17474930221114562] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The interrelationships between gait, cerebral small vessel disease (CSVD), and cognitive impairments in aging are not well-understood-despite their common co-occurrence. OBJECTIVE To systematically review studies of gait impairment in CSVD, pre-dementia, and dementia, and to identify key gaps for future research and novel pathways toward intervention. METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided search strategy was implemented in PubMed to identify relevant studies. Potential articles (n = 263) published prior to 1 December 2021 were screened by two reviewers. Studies with sample sizes >20 and including some adults over > 65 years (n = 202) were included. RESULTS The key findings were that (1) adverse gait and cognitive outcomes were associated with several (rather than select) CSVD pathologies distributed across the brain, and (2) poor gait and CSVD pathologies were more strongly associated with dementia with a vascular, rather than an Alzheimer's disease-related, cause. DISCUSSION A better understanding of the interrelationships between gait performance in CSVD, pre-dementia, and dementia requires studies examining (1) comprehensive patterns in the clinical manifestations of CSVD, (2) racially/ethnically diverse samples, (3) samples followed for extended periods of time or across the adult life span, (4) non-traditional CSVD neuroimaging markers (e.g. resting-state functional magnetic resonance imaging (fMRI)), and (5) continuous (e.g. wearable sensors) and complex (e.g. dual-task) walking performance.
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Affiliation(s)
- Helena M Blumen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Oshadi Jayakody
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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3
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Pozorski V, Oh JM, Okonkwo O, Krislov S, Barzgari A, Theisen F, Sojkova J, Bendlin BB, Johnson SC, Gallagher CL. Cross-sectional and longitudinal associations between total and regional white matter hyperintensity volume and cognitive and motor function in Parkinson's disease. Neuroimage Clin 2019; 23:101870. [PMID: 31150958 PMCID: PMC6543018 DOI: 10.1016/j.nicl.2019.101870] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND White matter hyperintensities (WMH) are frequently observed on T2-weighted brain magnetic resonance imaging studies of healthy older adults and have been linked with impairments in balance, gait, and cognition. Nonetheless, few studies have investigated the longitudinal effects of comorbid WMH on cognition and motor function in Parkinson's disease. METHODS The Lesion Segmentation Tool for Statistical Parametric Mapping was used to obtain total lesion volume and map regional WMH probabilities in 29 PD and 42 control participants at two study visits 18 months apart. Both cross-sectional and longitudinal comparisons were made between composite scores in the domains of executive function, memory, and language, and Unified Parkinson's Disease Rating Scale (UPDRS) scores. RESULTS We found no difference between disease and control groups in total WMH volume or progression during the study. Greater regional and global WMH at baseline was more strongly associated with lower executive function in PD subjects than in controls. Increased regional WMH was also more strongly associated with impaired memory performance in PD relative to controls. Longitudinally, no associations between cognitive change and total or regional WMH progression were detected in either group. A positive relationship between baseline regional WMH and total UPDRS scores was present in the control group, but not PD. However, greater WMH increase was associated with a greater increase in UPDRS motor sub-scores in PD. CONCLUSIONS These findings suggest that although PD patients do not experience greater mean WMH load than normal aged adults, comorbid WMH do exacerbate cognitive and motor symptoms in PD.
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Affiliation(s)
- Vincent Pozorski
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jennifer M Oh
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ozioma Okonkwo
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Stephanie Krislov
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Amy Barzgari
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Frances Theisen
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jitka Sojkova
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Barbara B Bendlin
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sterling C Johnson
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Catherine L Gallagher
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Tap L, van Opbroek A, Niessen WJ, Smits M, Mattace-Raso FU. Aortic stiffness and brain integrity in elderly patients with cognitive and functional complaints. Clin Interv Aging 2018; 13:2161-2167. [PMID: 30464425 PMCID: PMC6211313 DOI: 10.2147/cia.s181437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose Cerebral white matter lesions (WML) and brain atrophy are frequent in older persons and are associated with adverse outcomes. It has been suggested that aortic stiffness plays a role in the pathogenesis of WML and gray matter (GM) loss. There is, however, little evidence on the association between aortic stiffness and brain integrity in older patients. In this study, we investigated whether aortic stiffness is associated with WML and GM volume in older patients with cognitive and functional complaints. Patients and methods Fazekas score was used to analyze WML on brain imaging data of 84 persons; in a subanalysis on 42 MRI scans, the exact volume of white matter hyperintensities (WMH) and GM was determined using a brain-tissue and WMH tool. Aortic stiffness, measured as aortic pulse wave velocity (aPWV) and central pulse pressure (cPP), and blood pressure levels were non-invasively measured by the Mobil-O-Graph. Results Mean age was 76.6 (±6.8) years. Age was correlated with cPP (Spearman's ρ =0.296, P=0.008), aPWV (r 2=0.785, P<0.001) and WMH volume (r 2=0.297, P<0.001). cPP did not differ between categories of Fazekas, whereas aPWV increased with increasing Fazekas score (P for trend <0.001). After additional adjustment for age, levels of aPWV did not differ between categories. Both cPP and aPWV were associated with WMH volumes (lnB 0.025, P=0.055 and lnB 0.405, P<0.001, respectively); after additional adjustment for age, estimates were less consistent. Both cPP and aPWV were negatively associated with GM volumes in multivariate analysis (B=2.805, P=0.094 and B=111.052, P=0.032). Conclusion Higher aortic stiffness was partly associated with increased volume of WMH and decreased volume of GM and slightly influenced by blood pressure. Age also plays a role in this association in older patients.
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Affiliation(s)
- Lisanne Tap
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands,
| | - Annegreet van Opbroek
- Department of Medical Informatics and Radiology, Biomedical Imaging Group Rotterdam, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wiro J Niessen
- Department of Medical Informatics and Radiology, Biomedical Imaging Group Rotterdam, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Francesco Us Mattace-Raso
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands,
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Pettersson AF, Wahlund LO, Bronge L, Olsson E, Amberla K, Baezner H, Crisby M. Physical activity level in people with age related white matter changes correlates to better motor performance, lower comorbidity and higher cognitive level. BMC Geriatr 2017; 17:142. [PMID: 28701206 PMCID: PMC5508703 DOI: 10.1186/s12877-017-0535-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/04/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Physical activity plays a pivotal role in the development of disability and may modify the negative effect of vascular risk factors on progression of both cardio and cerebrovascular disorders. The aim of this study was to evaluate the activity level in people with age-related white matter changes as identified on magnetic resonance imaging (MRI) in relation to motor performance, cognition and perceived health. METHODS Data came from the first year follow up of one participating centers of the LADIS study. Fifty one subjects were first enrolled in the study. Complete first year follow up data was available for 41 subjects. Information on comorbidity, physical activity level, physical function, cognition, level of white matter changes and perceived health was collected. Physical activity level was classified with a yes or no question and with the Frenchay Activities Index (FAI). RESULTS Only 36% of the subjects in this study were physically active according to the yes/no question. 27.5% of the subjects were active according to the FAI score which evaluates the everyday activities. Being active discriminated subjects with better physical function. Subjects active according to the FAI score had a higher cognitive level (p ≤ 0.01), lower comorbidity (p = 0.02) and performed better on all motor function tasks as assessed by walking speed (p ≤ 0.01) and the Short Physical Performance battery (SPPB) (p ≤ 0.01). CONCLUSIONS Being physically active seems to be a long term protective factor. In our study, the majority of subjects with Age Related White Mattter Changes (ARWMC) with no or mild Instrumental Activity of Daily Living (IADL) disability did not attain recommended level of activity at first year follow up. Whether or not increasing physical activity may slow down cognitive decline and lessen development of disability in physically inactive subjects with manifest ARWC remains to be studied. TRIAL REGISTRATION not applicable.
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Affiliation(s)
- Anna F Pettersson
- Division of Physiotherapy, Karolinska Institutet, Neurobiology Care Sciences and Society, 23 100, 141 83, Huddinge, Sweden.
| | - Lars-Olof Wahlund
- Division of Clinical Geriatrics, Karolinska Institutet, Neurobiology Care Sciences and Society, Huddinge, Sweden
| | - Lena Bronge
- Division of Radiology, CLINTEC Department, Karolinska Institutet, Huddinge, Sweden
| | - Elisabeth Olsson
- Division of Physiotherapy, Karolinska Institutet, Neurobiology Care Sciences and Society, 23 100, 141 83, Huddinge, Sweden
| | - Kaarina Amberla
- Department of Clinical Psychology, Helsinki University, Helsinki, Finland
| | - Hansjoerg Baezner
- Department of Neurology, Universitätsklinikum Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Milita Crisby
- Division of Clinical Geriatrics, Karolinska Institutet, Neurobiology Care Sciences and Society, Huddinge, Sweden.
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Benítez-Rivero S, Palomar FJ, Martín-Rodríguez JF, Álvarez de Toledo P, Lama MJ, Huertas-Fernández I, Cáceres-Redondo MT, Porcacchia P, Mir P. Abnormal sensorimotor integration correlates with cognitive profile in vascular parkinsonism. J Neurol Sci 2017; 377:161-166. [PMID: 28477688 DOI: 10.1016/j.jns.2017.03.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 03/06/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Sonia Benítez-Rivero
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Francisco J Palomar
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Juan F Martín-Rodríguez
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Paloma Álvarez de Toledo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - María J Lama
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Ismael Huertas-Fernández
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - María T Cáceres-Redondo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Paolo Porcacchia
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain.
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Abraham HMA, Wolfson L, Moscufo N, Guttmann CRG, Kaplan RF, White WB. Cardiovascular risk factors and small vessel disease of the brain: Blood pressure, white matter lesions, and functional decline in older persons. J Cereb Blood Flow Metab 2016; 36:132-42. [PMID: 26036933 PMCID: PMC4758547 DOI: 10.1038/jcbfm.2015.121] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 04/30/2015] [Accepted: 05/11/2015] [Indexed: 01/05/2023]
Abstract
Several potential vascular risk factors exist for the development and accumulation of subcortical white matter disease in older people. We have reported that in older people followed for up to 4 years white matter hyperintensity (WMH) lesions on magnetic resonance imaging nearly doubled in volume and were associated with alterations in mobility and cognitive function. Herein we review the genetic, metabolic, and vascular risk factors that have been evaluated in association with the development and pathogenesis of WMH in older persons. Our research efforts have focused on systemic hypertension, particularly in the out-of-office setting as 24-hour ambulatory blood pressure (BP) has proven to be a stronger indicator of the progression of WMH in older people and the associated functional decline than doctor’s office BP. Based on relations between 24-hour systolic BP levels, the accrual of WMH, and functional decline, we have designed the INFINITY trial, the first interventional study to use ambulatory BP to guide antihypertensive therapy to address this problem in the geriatric population.
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Affiliation(s)
- Hazel Mae A Abraham
- Calhoun Cardiology Center and Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Leslie Wolfson
- Department of Neurology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Nicola Moscufo
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Charles R G Guttmann
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard F Kaplan
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - William B White
- Calhoun Cardiology Center and Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Moretti R, Cavressi M, Tomietto P. Gait and apathy as relevant symptoms of subcortical vascular dementia. Am J Alzheimers Dis Other Demen 2015; 30:390-9. [PMID: 25204314 PMCID: PMC10852560 DOI: 10.1177/1533317514550329] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Subcortical vascular dementia relates to small-vessel disease and hypoperfusion, resulting in focal and diffuse ischemic white matter lesions. The main target of the disease are the frontal subcortical neural networks. There is no clinical standard definition of the pathology, on the contrary, everyday clinical practice suggests dominant behavioral alterations and dysexecutive syndrome. METHODS The aim of this study was to investigate gait disorders, behavioral alteration, and drug intake of a subcortical population with dementia (n = 1155). A complete neuropsychological examination was conducted at baseline and every 6 months, and the results were compared. RESULTS Our data suggest that there is a significant increment in apathy levels and a dramatic decrease in gait and equilibrium control in the patients examined during follow-up. CONCLUSION Subcortical vascular dementia may be associated with gait and balance alteration and apathy per se; we suggest to implement clinical data with these major aspects.
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Affiliation(s)
- Rita Moretti
- Clinica Neurologica, Responsabile Ambulatorio Complicanze Internistiche Cerebrali, Dipartimento Universitario Clinico di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
| | | | - Paola Tomietto
- Medicina Clinica, Servizio Reumatologia, Ospedale Cattinara, Trieste, Italy
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Terashi H, Utsumi H, Ishimura Y, Aizawa H, Yoneyama M, Mitoma H. Kinematic analysis of 24-hour recording of walking pattern in patients with vascular parkinsonism. Int J Neurosci 2014; 125:733-41. [DOI: 10.3109/00207454.2014.967350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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Kuroiwa Y, Miyano I, Nishinaga M, Takata J, Shimizu Y, Okumiya K, Matsubayashi K, Ozawa T, Kitaoka H, Doi Y, Yasuda N. Association between level of brachial-ankle pulse wave velocity and onset of activities of daily living impairment in community-dwelling older individuals. Geriatr Gerontol Int 2014; 15:840-7. [PMID: 25406937 DOI: 10.1111/ggi.12356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2014] [Indexed: 12/25/2022]
Abstract
AIM The purpose of the present study was to clarify the longitudinal association between brachial-ankle pulse wave velocity (baPWV) and the onset of impairment in activities of daily living (ADL) among community-dwelling individuals. METHODS Deaths and the onsets of ADL impairment during 3 years were followed for 450 individuals without ADL impairment at entry who were aged 65 years or older (men : women 181:269; mean age 77 years). They were dichotomized on the median baPWV value at entry. RESULTS Within 3 years, 28 died and 60 had an onset of ADL impairment. The high baPWV group had a higher incidence of deaths (high baPWV group vs low baPWV group, 9.3% vs 3.1%) and ADL impairment (high baPWV group vs low baPWV group, 20.7% vs 9.3%). After adjustment for age, sex and systolic blood pressure, as compared with the low baPWV group, the high baPWV group had increased risk for mortality (adjusted odds ratio 3.22; 95% confidence interval 1.26-8.22) and the onset of ADL impairment (adjusted odds ratio 1.94; 95% confidence interval 1.03-3.63). When the onset of ADL impairment was grouped according to medical conditions that preceded/accompanied the onset of ADL impairment, elevated baPWV was associated with increased risk for the onset of ADL impairment after/accompanying fall/fracture. CONCLUSIONS The assessment of arterial stiffness by baPWV contributes to identifying functionally independent community-dwelling older individuals at risk for ADL impairment, in particular ADL impairment associated with fall/fracture, as well as for mortality. Geriatr Gerontol Int 2015; 15: 840-847.
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Affiliation(s)
- Yumi Kuroiwa
- Department of Public Health, Kochi Medical School, Nankoku, Japan
| | - Ichiro Miyano
- Department of Public Health, Kochi Medical School, Nankoku, Japan
| | - Masanori Nishinaga
- Department of Internal Medicine, Saitama Memorial Hospital, Saitama, Japan
| | - Jun Takata
- The Center to Promote Creativity in Medical Education, Kochi Medical School, Nankoku, Japan
| | - Yuji Shimizu
- Department of Medicine and Geriatrics, Kochi Medical School, Nankoku, Japan
| | | | - Kozo Matsubayashi
- The Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | - Toshio Ozawa
- Department of Medicine and Geriatrics, Kochi Medical School, Nankoku, Japan
| | - Hiroaki Kitaoka
- Department of Medicine and Geriatrics, Kochi Medical School, Nankoku, Japan
| | - Yoshinori Doi
- Department of Medicine and Geriatrics, Kochi Medical School, Nankoku, Japan
| | - Nobufumi Yasuda
- Department of Public Health, Kochi Medical School, Nankoku, Japan
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11
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Pasma JH, Bijlsma AY, Klip JM, Stijntjes M, Blauw GJ, Muller M, Meskers CGM, Maier AB. Blood pressure associates with standing balance in elderly outpatients. PLoS One 2014; 9:e106808. [PMID: 25222275 PMCID: PMC4164445 DOI: 10.1371/journal.pone.0106808] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 08/05/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Assessment of the association of blood pressure measurements in supine and standing position after a postural change, as a proxy for blood pressure regulation, with standing balance in a clinically relevant cohort of elderly, is of special interest as blood pressure may be important to identify patients at risk of having impaired standing balance in routine geriatric assessment. MATERIALS AND METHODS In a cross-sectional cohort study, 197 community-dwelling elderly referred to a geriatric outpatient clinic of a middle-sized teaching hospital were included. Blood pressure was measured intermittently (n = 197) and continuously (subsample, n = 58) before and after a controlled postural change from supine to standing position. The ability to maintain standing balance was assessed during ten seconds of side-by-side, semi-tandem and tandem stance, with both eyes open and eyes closed. Self-reported impaired standing balance and history of falls were recorded by questionnaires. Logistic regression analyses were used to examine the association between blood pressure and 1) the ability to maintain standing balance; 2) self-reported impaired standing balance; and 3) history of falls, adjusted for age and sex. RESULTS Blood pressure decrease after postural change, measured continuously, was associated with reduced ability to maintain standing balance in semi-tandem stance with eyes closed and with increased self-reported impaired standing balance and falls. Presence of orthostatic hypotension was associated with reduced ability to maintain standing balance in semi-tandem stance with eyes closed for both intermittent and continuous measurements and with increased self-reported impaired standing balance for continuous measurements. CONCLUSION Continuous blood pressure measurements are of additional value to identify patients at risk of having impaired standing balance and may therefore be useful in routine geriatric care.
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Affiliation(s)
- Jantsje H. Pasma
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Astrid Y. Bijlsma
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Section of Gerontology and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Janneke M. Klip
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marjon Stijntjes
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Section of Gerontology and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Gerard Jan Blauw
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Geriatrics, Bronovo Hospital, The Hague, The Netherlands
| | - Majon Muller
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Carel G. M. Meskers
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Andrea B. Maier
- Department of Internal Medicine, Section of Gerontology and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands
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Callisaya ML, Beare R, Phan T, Blizzard L, Thrift AG, Chen J, Srikanth VK. Progression of white matter hyperintensities of presumed vascular origin increases the risk of falls in older people. J Gerontol A Biol Sci Med Sci 2014; 70:360-6. [PMID: 25199911 DOI: 10.1093/gerona/glu148] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Greater volume of cerebral white matter hyperintensities (WMH) of presumed vascular origin may affect postural control and gait. WMH measured at one time point predicts an increased risk of incident multiple falls. However, it is unknown whether WMH progression increases falls risk. We hypothesized that the progression of WMH would be associated with a greater risk of multiple falls. METHODS A population-based sample aged more than 60 years was randomly selected from the electoral roll and followed up 2.5 years apart with two phases of measurement. Magnetic resonance imaging scans from both time points were subjected to automated segmentation to derive WMH volumes. Falls were recorded prospectively over 12 months after the second magnetic resonance imaging measurement. A generalized linear model was used to estimate the relative risk of multiple falls associated with WMH progression adjusted for confounders. RESULTS There were 187 people (mean age 70.4, SD 6.5) with a mean follow-up of 2.5 (SD 0.4) years. Over 12 months, 35 (18.7%) participants reported multiple falls. A greater progression of WMH was associated with an increased risk of multiple falls (adjusted relative risk 1.30, 95% confidence interval 1.00-1.70, p = .05) independent of baseline WMH volume, duration of follow-up, age, sex, and total intracranial volume. This association was unchanged when adjusted for medical history, peripheral sensorimotor factors, gait speed, cognition, medications, mood, and magnetic resonance imaging infarcts. CONCLUSION Greater WMH progression independently increased the risk of multiple falls. Interventions to slow the progression of WMH may be successful in reducing this risk.
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Affiliation(s)
- Michele L Callisaya
- Stroke and Ageing Research, Department of Medicine, Southern Clinical School, Monash University, Melbourne, Victoria, Australia. Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia.
| | - Richard Beare
- Stroke and Ageing Research, Department of Medicine, Southern Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Thanh Phan
- Stroke and Ageing Research, Department of Medicine, Southern Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Leigh Blizzard
- Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, Southern Clinical School, Monash University, Melbourne, Victoria, Australia. Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Jian Chen
- Southern Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Velandai K Srikanth
- Stroke and Ageing Research, Department of Medicine, Southern Clinical School, Monash University, Melbourne, Victoria, Australia. Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
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13
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Association Between the Volume of Carotid Artery Plaque and Its Subcomponents and the Volume of White Matter Lesions in Patients Selected for Endarterectomy. AJR Am J Roentgenol 2013; 201:W747-52. [DOI: 10.2214/ajr.12.10217] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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14
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Wolfson L, Wakefield DB, Moscufo N, Kaplan RF, Hall CB, Schmidt JA, Guttmann CRG, White WB. Rapid buildup of brain white matter hyperintensities over 4 years linked to ambulatory blood pressure, mobility, cognition, and depression in old persons. J Gerontol A Biol Sci Med Sci 2013; 68:1387-94. [PMID: 23766429 DOI: 10.1093/gerona/glt072] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Brain white matter hyperintensities (WMH) are associated with functional decline in older people. We performed a 4-year cohort study examining progression of WMH, its effects on mobility, cognition, and depression with the role of clinic and 24-hour ambulatory systolic blood pressure as a predisposing factor. METHODS Ninety-nine subjects, 75-89 years were stratified by age and mobility, with the 67 completing 4-years comprising the cohort. Mobility, cognition, depressive symptoms, and ambulatory blood pressure were assessed, and WMH volumes were determined by quantitative analysis of magnetic resonance images. RESULTS WMH increased from 0.99±0.98% of intracranial cavity volume at baseline to 1.47±1.2% at 2 years and 1.74±1.30% after 4 years. Baseline WMH was associated with 4-year WMH (p < .0001), explaining 83% of variability. Small, but consistent mobility decrements and some evidence of cognitive decline were noted over 4 years. Regression analyses using baseline and 4-year WMHs were associated with three of five mobility measures, two of four cognitive measures and the depression scale, all performed at 4 years. Increases in ambulatory systolic blood pressure but not clinic systolic blood pressure during the initial 2 years were associated with greater WMH accrual during those years, while ambulatory systolic blood pressure was related to WMH at 4 years. CONCLUSION Declines in mobility, cognition, and depressive symptoms were related to WMH accrual over 4 years, and WMH was related to out-of-office blood pressure. This suggests that prevention of microvascular disease, even in asymptomatic older persons, is fundamental for preserving function. There may be value in tighter 24-hour blood pressure control in older persons although this requires further investigation.
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Affiliation(s)
- Leslie Wolfson
- Professor and Chair, Department of Neurology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030.
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15
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White WB, Marfatia R, Schmidt J, Wakefield DB, Kaplan RF, Bohannon RW, Hall CB, Guttmann CR, Moscufo N, Fellows D, Wolfson L. INtensive versus standard ambulatory blood pressure lowering to prevent functional DeclINe in the ElderlY (INFINITY). Am Heart J 2013; 165:258-265.e1. [PMID: 23453090 DOI: 10.1016/j.ahj.2012.11.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 11/11/2012] [Indexed: 11/26/2022]
Abstract
Reductions in mobility and cognitive function linked to accrual of brain microvascular disease related white matter hyperintensities (WMHs) on magnetic resonance imaging can occur in older hypertensive patients in as little as 2 years. We have designed a trial evaluating 2 levels of ambulatory blood pressure (ABP) control in individuals with normal or mildly impaired mobility and cognition who have detectable cerebrovascular disease (>0.5% WMH fraction of intracranial volume) on functional outcomes. The study is a prospective randomized, open-label trial with blinded end points, in patients ages ≥75 years with elevated 24-hour systolic blood pressure (BP) (145 mm Hg in the untreated state) who do not have unstable cardiovascular disease, heart failure, or stroke. The primary and key secondary outcomes in the trial are change from baseline in mobility and cognitive function and damage to brain white matter as demonstrated by accrual of WMH volume and changes in diffusion tensor imaging. Approximately 300 patients will be enrolled, and 200 randomized to 1 of 2 levels of ABP control (intensive to achieve a goal 24-hour systolic BP of ≤130 mm Hg or standard to achieve a goal 24-hour systolic BP of ≤145 mm Hg) for a total of 36 months using similar antihypertensive regimens. The analytical approach provides 85% power to show a clinically meaningful effect in differences in mobility accompanied by quantitative differences in WMH between treatment groups. The INFINITY trial is the first to guide antihypertensive therapy using ABP monitoring rather than clinic BP to reduce cerebrovascular disease.
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16
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17
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Petrovic IN, Stefanova E, Kozic D, Semnic R, Markovic V, Daragasevic NT, Kostic VS. White matter lesions and depression in patients with Parkinson's disease. J Neurol Sci 2012; 322:132-6. [DOI: 10.1016/j.jns.2012.07.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 07/01/2012] [Accepted: 07/10/2012] [Indexed: 10/28/2022]
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18
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Annweiler C, Beauchet O, Celle S, Roche F, Annweiler T, Allali G, Bartha R, Montero-Odasso M. Contribution of brain imaging to the understanding of gait disorders in Alzheimer's disease: a systematic review. Am J Alzheimers Dis Other Demen 2012; 27:371-80. [PMID: 22930697 PMCID: PMC11008139 DOI: 10.1177/1533317512454710] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Although gait disorders are common in Alzheimer's disease (AD), determining which brain structures and related lesions are specifically involved is a goal yet to be reached. Our objective was to systematically review all published data that examined associations between gait disorders and brain imaging in AD. Of 486 selected studies, 4 observational studies met the selection criteria. The number of participants ranged from 2 to 61 community dwellers (29%-100% female) with prodromal or dementia-stage AD. Quantitative gait disorders (ie, slower gait velocity explained by shorter stride length) were associated with white matter lesions, mainly in the medial frontal lobes and basal ganglia. The nigrostriatal dopamine system was unaffected. Qualitative gait disorders (ie, higher stride length variability) correlated with lower hippocampal volume and function. Gait disorders in AD could be explained by a high burden of age-related subcortical hyperintensities on the frontal-subcortical circuits (nonspecific) together with hippocampal atrophy and hypometabolism (specific).
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Affiliation(s)
- Cédric Annweiler
- Division of Geriatric Medicine, Department of Medicine, Parkwood Hospital, St. Joseph's Health Care, London, Ontario, Canada.
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19
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Vale TC, Barbosa MT, Caramelli P, Cardoso F. Vascular Parkinsonism and cognitive impairment: literature review, Brazilian studies and case vignettes. Dement Neuropsychol 2012; 6:137-144. [PMID: 29213787 PMCID: PMC5618960 DOI: 10.1590/s1980-57642012dn06030005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Vascular Parkinsonism (VP) is a form of secondary Parkinsonism resulting from
cerebrovascular disease. Estimates of the frequency of VP vary greatly
worldwide; 3% to 6% of all cases of Parkinsonism are found to have a vascular
etiology. In a Brazilian community-based study on Parkinsonism, 15.1% of all
cases were classified as VP, the third most common form, with a prevalence of
1.1% in an elderly cohort. Another Brazilian survey found a prevalence of 2.3%
of VP in the elderly. VP is usually the result of conventional vascular risk
factors, particularly hypertension, leading to strategic infarcts of subcortical
gray matter nuclei, diffuse white matter ischaemic lesions and less commonly,
large vessel infarcts. Patients with VP tend to be older and present with gait
difficulties, symmetrical predominant lower-body involvement, poor levodopa
responsiveness, postural instability, falls, cognitive impairment and dementia,
corticospinal findings, urinary incontinence and pseudobulbar palsy. This
article intends to provide physicians with an insight on the practical issues of
VP, a disease potentially confounded with vascular dementia, idiopathic
Parkinson's disease, dementia with Lewy bodies and other secondary causes of
Parkinsonism.
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Affiliation(s)
- Thiago Cardoso Vale
- Neurology Division, University Hospital, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte MG, Brazil
| | - Maira Tonidandel Barbosa
- Internal and Geriatric Medicine, Internal Medicine Department, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte MG, Brazil
| | - Paulo Caramelli
- Neurology Division, University Hospital, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte MG, Brazil
| | - Francisco Cardoso
- Neurology Division, University Hospital, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte MG, Brazil
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Impact of subcortical hyperintensities on dual-tasking in Alzheimer disease and aging. Alzheimer Dis Assoc Disord 2012; 26:28-35. [PMID: 21502852 DOI: 10.1097/wad.0b013e3182172c58] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Subcortical hyperintensities (SHs) on brain magnetic resonance imaging are associated with cognitive and gait impairment in elderly but their impact on dual-tasking (performing cognitive tasks while walking) in patients with Alzheimer disease (AD) is unknown. This study explored the costs of dual-tasking in relation to SH severity in AD and normal controls (NCs). Cadence while walking on a treadmill, and speed-accuracy-tradeoff (SAT), on 3 working memory tasks, were measured during single-task and dual-task conditions. Dual-task costs (DTC) on SAT, cadence, and overall DTC were measured for each of these tasks. On visual rating of SH severity, AD and NC groups were subdivided into high-SH and low-SH subgroups. Compared with the NC, the AD group performed poorly on all working memory tasks across both conditions, decreased cadence on dual-tasking, and showed a decrement in overall DTC (all P<0.01). When grouped according to SH severity, the low-SH-NC group performed superiorly on working memory tasks (P<0.001) and the high-SH-AD group (P=0.001) showed a decrease in dual-task costs of cadence. Although the AD group showed a decrement in overall DTC (P<0.01) compared with NC, when assessed in terms of SH severity, the high-SH-AD group showed the largest decrement in DTC (P<0.01). Greater SH severity is associated with a decrement in overall dual-tasking ability in AD.
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21
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Moscufo N, Wolfson L, Meier D, Liguori M, Hildenbrand PG, Wakefield D, Schmidt JA, Pearlson GD, Guttmann CRG. Mobility decline in the elderly relates to lesion accrual in the splenium of the corpus callosum. AGE (DORDRECHT, NETHERLANDS) 2012; 34:405-414. [PMID: 21505765 PMCID: PMC3312641 DOI: 10.1007/s11357-011-9242-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 03/18/2011] [Indexed: 05/30/2023]
Abstract
In a previous cross-sectional study on baseline data, we demonstrated that the volume of brain white matter hyperintensities (WMH) in the splenium of corpus callosum (SCC) predicted the current mobility function of older persons. The primary aim of this follow-up study was to determine the relation of WMH volume change in SCC (SCC-∆WMH) with change in mobility measures. A secondary aim was to characterize the global and regional progression of WMH. Mobility function and WMH burden were evaluated at baseline and at 2 years in 77 community-dwelling individuals (baseline age, 82 ± 4). Regional WMH in SCC, as well as genu and body of corpus callosum, subregions of corona radiata, and superior longitudinal fasciculus were determined using a white matter parcellation atlas. The total WMH volume increased 3.3 ± 3.5 ml/year, mainly through enlargement. Significant WMH increases were observed in all selected regions, particularly within the corona radiata. While at baseline and follow-up we observed correlations between WMH burden and several measures of mobility, longitudinal change correlated only with change in chair rise (CR). SCC-∆WMH showed the highest correlation (r = -0.413, p = 0.0002) and was the best regional predictor of CR decline (OR = 1.5, r(2) = 0.3). The SCC-∆WMH was more than five times larger in the CR-decline group compared to the no-decline group (p = 0.0003). The SCC-∆WMH (top quartile) showed a higher sensitivity/specificity for CR decline compared to change in total WMH, 63/88% versus 52/84%, respectively. The findings suggest that accrual of WMHs in posterior areas of the brain supporting inter-hemispheric integration and processing of visual-spatial information is a mechanism contributing to age-related mobility deterioration.
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Affiliation(s)
- Nicola Moscufo
- Center for Neurological Imaging, Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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22
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Petrou M, Kotagal V, Bohnen NI. An update on brain imaging in parkinsonian dementia. ACTA ACUST UNITED AC 2012; 4:201-213. [PMID: 22768021 DOI: 10.2217/iim.12.10] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Disturbances of cognition are frequent in Parkinson's disease (PD). Unlike severe loss of dopamine early in PD, extensive cholinergic losses have been consistently reported in PD with dementia. Cholinergic imaging suggests that basal forebrain cholinergic system degeneration appears early in PD and worsens with dementia development. Cortical cholinergic denervation is similar in PD with dementia and dementia with Lewy bodies, supporting a common disease spectrum, at least with respect to cholinergic pathology. Presence of cerebral amyloidopathy in the setting of parkinsonism may accelerate cognitive decline. Novel MRI techniques illustrate the widespread presence of neurodegeneration in PD with dementia, affecting white matter tracts and connectivity functions. This review will outline current concepts regarding dementia development in PD and discuss their correlation with functional and structural neuroimaging including PET and MRI.
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Zheng JJJ, Lord SR, Close JCT, Sachdev PS, Wen W, Brodaty H, Delbaere K. Brain White Matter Hyperintensities, Executive Dysfunction, Instability, and Falls in Older People: A Prospective Cohort Study. J Gerontol A Biol Sci Med Sci 2012; 67:1085-91. [PMID: 22403055 DOI: 10.1093/gerona/gls063] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jacqueline J J Zheng
- Falls and Balance Research Group, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
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Taniguchi Y, Yoshida H, Fujiwara Y, Motohashi Y, Shinkai S. A prospective study of gait performance and subsequent cognitive decline in a general population of older Japanese. J Gerontol A Biol Sci Med Sci 2012; 67:796-803. [PMID: 22389458 DOI: 10.1093/gerona/glr243] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Gait speed is a good predictor of cognitive decline in later life. However, it is not known whether step length or step frequency is better for predicting such decline. This study aimed to compare the predictive value for cognitive decline of gait performance measures in a population of older Japanese. METHODS Among 853 cognitively intact adults aged 70 years or older who participated in a baseline survey, 666 (mean age, 75.5 [SD 4.4] years; women, 59.3%) were reevaluated at least once during the subsequent 4-year period. Cognition was assessed by Mini-Mental State Examination (MMSE), and cognitive decline was defined as a decrease of three points or more on the Mini-Mental State Examination during follow-up. RESULTS During a median follow-up of 2.7 years, 110 adults (16.5%) had cognitive decline. Among the measures of gait performance (speed, step length, and frequency), step length was the most predictive of cognitive decline. After controlling for important confounders, older men in the lowest and middle tertiles of step length at maximum speed and older women in the lowest and middle tertiles of step length at usual speed were 4.42 (95% confidence interval: 1.65-11.8), 2.17 (0.82-5.71), 5.76 (2.15-15.4), and 2.44 (0.94-6.35) times as likely to develop cognitive decline, respectively, as those of the same sex and walking speed who were in the highest tertile. CONCLUSIONS Step length was an independent predictor of cognitive decline in a general population of older adults and may be a better predictor than overall gait speed of such decline.
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Affiliation(s)
- Yu Taniguchi
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan.
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Abstract
Gait and balance problems are common with advancing age. Disorders of balance and gait are particularly important in the elderly because they compromise independence and contribute to the risk of falls and injury. Although they are considered as separate clinical entities, balance and gait disturbance are often intertwined. Here, we discuss the principal anatomical and physiologic mechanisms responsible for balance and gait. We also review the different types of fall patterns commonly seen in subjects and a classification scheme for various gait disorders. Furthermore, we consider the relationship between balance and gait disorders and subcortical vascular disease. Potential interventions and therapies in those individuals with balance and gait disorders are also discussed.
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Affiliation(s)
- Anand Viswanathan
- Stroke Service and Neurology Clinical Trials Unit, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.
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Abstract
The precise anatomy and physiology of human walking remains poorly understood. The frontal lobes appear crucial, and, on the basis of clinical observation, contribute to the control of truncal motion, postural responses, and the maintenance of equilibrium and locomotion. The rich repertoire of frontal gait disorders gives some indication of this complexity. Variable combinations of disequilibrium with a wide stance base, increased body sway and falls, loss of control of truncal motion, locomotor disability with gait ignition failure, start hesitation, shuffling, and freezing are encountered in diseases of the frontal lobes. Furthermore, the pattern of gait may change as the frontal disease progresses. The slowness of walking, lack of heel-shin or upper limb ataxia, dysarthria or nystagmus distinguishes the wide stance base from cerebellar gait ataxia. A lively facial expression, normal voluntary movements of the upper limbs, upper motor neuron signs, and the absence of a rest tremor distinguish the hypokinetic elements from Parkinson's disease. Poor truncal mobility, impaired postural responses, and falls after the slightest perturbation eventually make walking impossible even though simple leg movements may still be possible while seated or lying. One or more of these features usually predominates in the initial presentation of a frontal gait syndrome. Accordingly, there is considerable variation in the manner of presentation and evolution of frontal gait disorders. The gait syndrome is accompanied by frontal motor and cognitive changes, which may be subtle or overshadowed by the gait disorder. This complexity of clinical presentation accounts for the plethora of descriptions from "frontal ataxia" to "gait apraxia". As suggested in the original descriptions of frontal ataxia, the spectrum of gait disturbance is likely to be due to damage to frontal cortex and its connections with subcortical structures including the basal ganglia, cerebellum, and the brainstem.
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Affiliation(s)
- Philip D Thompson
- University Department of Medicine, University of Adelaide, Australia.
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27
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Sorond FA, Kiely DK, Galica A, Moscufo N, Serrador JM, Iloputaife I, Egorova S, Dell'Oglio E, Meier DS, Newton E, Milberg WP, Guttmann CRG, Lipsitz LA. Neurovascular coupling is impaired in slow walkers: the MOBILIZE Boston Study. Ann Neurol 2011; 70:213-20. [PMID: 21674588 DOI: 10.1002/ana.22433] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 03/03/2011] [Accepted: 03/18/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neurovascular coupling may be involved in compensatory mechanisms responsible for preservation of gait speed in elderly people with cerebrovascular disease. Our study examines the association between neurovascular coupling in the middle cerebral artery and gait speed in elderly individuals with impaired cerebral vasoreactivity. METHODS Twenty-two fast and 20 slow walkers in the lowest quartile of cerebral vasoreactivity were recruited from the MOBILIZE Boston Study. Neurovascular coupling was assessed in bilateral middle cerebral arteries by measuring cerebral blood flow during the N-Back task. Cerebral white matter hyperintensities were measured for each group using magnetic resonance imaging. RESULTS Neurovascular coupling was attenuated in slow compared to fast walkers (2.8%; 95% confidence interval [CI], -0.9 to 6.6 vs 8.2%; 95% CI, 4.7-11.8; p = 0.02). The odds ratio of being a slow walker was 6.4 (95% CI, 1.7-24.9; p = 0.007) if there was a high burden of white matter hyperintensity; however, this risk increased to 14.5 (95% CI, 2.3-91.1; p = 0.004) if neurovascular coupling was also attenuated. INTERPRETATION Our results suggest that intact neurovascular coupling may help preserve mobility in elderly people with cerebral microvascular disease.
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Affiliation(s)
- Farzaneh A Sorond
- Department of Neurology, Stroke Division, Brigham and Women's Hospital, Women's Hospital, Boston, MA 02115, USA.
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Zheng JJJ, Delbaere K, Close JCT, Sachdev PS, Lord SR. Impact of white matter lesions on physical functioning and fall risk in older people: a systematic review. Stroke 2011; 42:2086-90. [PMID: 21636821 DOI: 10.1161/strokeaha.110.610360] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE White matter lesions (WMLs) are common findings on neuroimaging in older people. This review systematically evaluates the published literature on the associations between WMLs and balance, gait, mobility, and falls in older people. METHODS Studies were identified with searches of the MEDLINE databases. Articles reporting associations between WMLs and balance, gait, mobility, and falls in older people in cross-sectional and longitudinal studies were included. RESULTS Thirty-one articles reporting data from 19 studies met the inclusion criteria. There were consistent findings from both cross-sectional and longitudinal studies indicating greater WML volumes are associated with impaired balance, slower gait, and reduced mobility. Most studies addressing regional WML distributions have reported that WMHs in the frontal lobe and periventricular regions show the strongest relationships with balance, gait, and mobility impairments. In relation to falls, a threshold effect was apparent in that only those with severe WML volumes were found to be at increased risk of falling. CONCLUSIONS The findings of this systematic review indicate that WMLs are common and are significantly associated with impaired balance, gait, mobility, and falls in older people. In many studies, however, impaired mobility and increased fall risk are only evident in people who have the most severe degree of WMLs.
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Nutt JG, Horak FB, Bloem BR. Milestones in gait, balance, and falling. Mov Disord 2011; 26:1166-74. [DOI: 10.1002/mds.23588] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Rosano C, Longstreth WT, Boudreau R, Taylor CA, Du Y, Kuller LH, Newman AB. High blood pressure accelerates gait slowing in well-functioning older adults over 18-years of follow-up. J Am Geriatr Soc 2011; 59:390-7. [PMID: 21391929 PMCID: PMC3637929 DOI: 10.1111/j.1532-5415.2010.03282.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine whether the association between hypertension and decline in gait speed is significant in well-functioning older adults and whether other health-related factors, such as brain, kidney, and heart function, can explain it. DESIGN Longitudinal cohort study. SETTING Cardiovascular Health Study. PARTICIPANTS Of 2,733 potential participants with a brain magnetic resonance imaging (MRI) scan, measures of mobility and systolic blood pressure (BP), no self-reported disability in 1992 to 1994 (baseline), and with at least 1 follow-up gait speed measurement through 1997 to 1999, 643 (aged 73.6, 57% female, 15% black) who had received a second MRI in 1997 to 1999 and an additional gait speed measure in 2005 to 2006 were included. MEASUREMENTS Mixed models with random slopes and intercepts were adjusted for age, race, and sex. Main explanatory factors included white matter hyperintensity progression, baseline cystatin-C, and left cardiac ventricular mass. Incidence of stroke and dementia, BP trajectories, and intake of antihypertensive medications during follow-up were tested as other potential explanatory factors. RESULTS Higher systolic BP was associated with faster rate of gait speed decline in this selected group of 643 participants, and results were similar in the parent cohort (N = 2,733). Participants with high BP (n = 293) had a significantly faster rate of gait speed decline than those with baseline BP less than 140/90 mmHg and no history of hypertension (n = 350). Rates were similar for those with history of hypertension who were uncontrolled (n = 110) or controlled (n = 87) at baseline and for those who were newly diagnosed (n = 96) at baseline. Adjustment for explanatory factors or for other covariates (education, prevalent cardiovascular disease, physical activity, vision, mood, cognition, muscle strength, body mass index, osteoporosis) did not change the results. CONCLUSION High BP accelerates gait slowing in well-functioning older adults over a long period of time, even for those who control their BP or develop hypertension later in life. Health-related measurements did not explain these associations. Future studies to investigate the mechanisms linking hypertension to slowing gait in older adults are warranted.
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Affiliation(s)
- Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Abstract
Pure vascular parkinsonism without evidence of nigral Lewy body pathology may occur as a distinct clinicopathological entity, but a much more frequent occurrence is the comorbid presence of age-associated white matter lesions (WMLs) in idiopathic Parkinson disease (PD). WMLs are associated with motor and cognitive symptoms in otherwise normal elderly individuals. Comorbid WMLs are, therefore, expected to contribute to clinical symptoms in PD. Studies of WMLs in PD differ with regard to methods of assessment of WML burden and the patient populations selected for analysis, but converging evidence suggests that postural stability and gait motor functions are predominantly affected. WMLs are described to contribute to dementia in Alzheimer disease, and emerging but inconclusive evidence indicates similar effects in PD. In this article, we review the literature addressing the occurrence and impact of WMLs in PD, and suggest that WMLs may exacerbate or contribute to some motor and cognitive deficits associated with PD. We review existing and emerging methods for studying white matter pathology in vivo, and propose future research directions.
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Auriel E, Bornstein NM, Berenyi E, Varkonyi I, Gabor M, Majtenyi K, Szepesi R, Goldberg I, Lampe R, Csiba L. Clinical, radiological and pathological correlates of leukoaraiosis. Acta Neurol Scand 2011; 123:41-7. [PMID: 20219022 DOI: 10.1111/j.1600-0404.2010.01341.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Leukoaraiosis is characterized by an abnormal appearance of the brain white matter on imaging. Its pathogenesis is still a matter of investigation. The purpose of this study was to investigate the radiological, clinical and pathological correlates of leukoaraiosis. METHODS The study population consisted of 93 deceased patients. The pre-mortem T2W magnetic resonance images were evaluated for the presence and grading of leukoaraiosis. The clinical and pathological characteristics based on the clinical charts and autopsy reports were evaluated. Tissue specimens of the blocks of 19 brains that demonstrated severe leukoaraiosis and those of five control brains were excised and stained. RESULTS The variables found to be significantly associated with leukoaraiosis were age and a clinical history of Parkinson's disease. Other risk factors and pathological markers of atherosclerosis were not significantly correlated with leukoaraiosis. No significant difference was found between the scoring of the myelin integrity, glial fibrillary acidic protein, cluster of differentiation 68 and smooth muscle actin. There was a significant difference with respect to thickening of vessels walls. CONCLUSIONS Our pathological results indicate that structural vascular abnormalities characterized by vessel wall thickening are associated with leukoaraiosis, supporting the assertion that vascular changes and ischemia generate leukoaraiosis. The relations between parkinsonism and leukoaraiosis may be explicable through vascular effects on the circuitry of the basal ganglia.
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Affiliation(s)
- E Auriel
- Stroke Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Wakefield DB, Moscufo N, Guttmann CR, Kuchel GA, Kaplan RF, Pearlson G, Wolfson L. White matter hyperintensities predict functional decline in voiding, mobility, and cognition in older adults. J Am Geriatr Soc 2010; 58:275-81. [PMID: 20374403 PMCID: PMC3764600 DOI: 10.1111/j.1532-5415.2009.02699.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare magnetic resonance imaging data with functional assessments of mobility, urinary control, and cognition to determine common or distinctive features in the distribution of brain white matter hyperintensities (WMHs) associated with functional decline and impairment. DESIGN Baseline data from subjects aged 75 to 89 enrolled in a longitudinal study. Assessors and subjects were blinded to group assignment. SETTING Healthy community-dwelling volunteers. PARTICIPANTS Ninety-nine subjects were enrolled using a balanced 3 x 3 matrix stratified according to age and mobility performance. Exclusion criteria were medication, systemic conditions, and neurological diseases that can compromise mobility. MEASUREMENTS WMHs were identified using a semi-automated segmentation method, and regional burdens were assessed using a white matter parcellation atlas. Quantitative measures of mobility, urinary incontinence (UI) severity, and executive function and processing speed were obtained. RESULTS WMHs occur predictably in predominantly periventricular areas. There were powerful correlations between total (tWMH) and regional (rWMH) WMH, with correlation coefficients of 0.5 to 0.9 for eight of 10 structures analyzed. tWMH predicted functional measures of UI, mobility, executive function, and processing speed nearly as well as the best regional measures. The total volume of WMHs independently explains 5% to 11% of the variability for mobility, UI severity, executive function, and processing speed and is a sensitive (0.7-0.8) predictor of functional decline. The odds of decline in each of the three functional domains was 1.5 to 2.4 times greater with each 1% increase in tWMH. CONCLUSION This work establishes the importance of brain WMH burden in three major geriatric syndromes. The findings support the inclusion of total WMH burden as a risk factor in the predictive and diagnostic criteria.
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Affiliation(s)
- Dorothy B. Wakefield
- Department of Neurology, University of Connecticut Health Center, Farmington, CT and Hartford Hospital, Hartford CT
| | - Nicola Moscufo
- Department of Radiology, Brigham & Women's Hospital, Boston, MA
| | | | | | - Richard F. Kaplan
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT
| | - Godfrey Pearlson
- Department of Psychiatry, Yale University, New Haven, CT and Institute of Living, Hartford, CT
| | - Leslie Wolfson
- Department of Neurology, University of Connecticut Health Center, Farmington, CT and Hartford Hospital, Hartford CT
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Gait disturbance associated with white matter changes: a gait analysis and blood flow study. Neuroimage 2009; 49:1659-66. [PMID: 19770057 DOI: 10.1016/j.neuroimage.2009.09.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 09/01/2009] [Accepted: 09/14/2009] [Indexed: 12/12/2022] Open
Abstract
To clarify the mechanisms underlying gait disturbance secondary to age-related white matter changes (ARWMC), cerebral perfusion was investigated during treadmill walking. Twenty subjects with extensive hyperintensities in the periventricular and deep white matter on T(2)-weighted magnetic resonance images (MRI) were recruited. The ARWMC subjects were classified into gait-disturbed (GD) and non-GD groups according to clinical criteria. All the subjects underwent gait analyses and cerebral perfusion measurements during both gait and rest by using single photon emission computed tomography. The GD group showed greater double support time/phase and stride width, and slower walking velocity, than the non-GD group. In an analysis of pooled data from all the subjects, gait-induced increases in cerebral perfusion were observed in the supplementary motor areas (SMA), lateral premotor cortex (PMC), primary motor and somatosensory areas, visual areas, basal ganglia and cerebellum. A between-group comparison of gait-induced perfusion changes showed relative underactivation of the SMA, thalamus and basal ganglia, together with relative overactivation of the PMC, in the GD group compared with the non-GD group. In a separate correlation analysis including all the subjects, as the double support phase was longer (that was, gait disturbance was more severe), the gait-induced perfusion changes were proportionally reduced in the SMA, visual cortex, and thalamus. The present study suggests that abnormalities in the basal ganglia-thalamo-cortical loops partly explain gait disturbance observed in a subset of subjects with ARWMC.
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Zimmerman ME, Lipton RB, Pan JW, Hetherington HP, Verghese J. MRI- and MRS-derived hippocampal correlates of quantitative locomotor function in older adults. Brain Res 2009; 1291:73-81. [PMID: 19631621 DOI: 10.1016/j.brainres.2009.07.043] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Revised: 07/08/2009] [Accepted: 07/15/2009] [Indexed: 11/28/2022]
Abstract
Gait measures have been shown to predict cognitive decline and dementia in older adults. Investigation of the neurobiology associated with locomotor function is needed to elucidate this relationship with cognitive abilities. This study aimed to examine magnetic resonance imaging (MRI; hippocampal volume)- and proton magnetic resonance spectroscopy (MRS; N-acetylaspartate to creatine (NAA/Cr) ratios)-derived hippocampal correlates of quantitative gait function (swing time (seconds), stride length (cm), and stride length variability (standard deviation)) in a subset of 48 nondemented older adults (24 males; mean age=81 years) drawn from the Einstein Aging Study, a community-based sample of individuals over the age of 70 residing in Bronx, New York. Linear regression analyses controlling for age were used to examine hippocampal volume and neurochemistry as predictors of gait function. We found that stride length was associated with hippocampal volume (beta=0.36, p=0.03; overall model R(2)=0.33, p=0.01), but not hippocampal neurochemistry (beta=0.09, p=0.48). Stride length variability was more strongly associated with hippocampal NAA/Cr (beta=-0.38, p=0.01; overall model R(2)=0.14, p=0.04) than hippocampal volume (beta=-0.33, p=0.08). Gait swing time was not significantly related to any neuroimaging measure. These relationships remained significant after accounting for memory and clinical gait impairments. These findings suggest that nondemented older adults exhibit increased stride length variability that is associated with lower levels of hippocampal neuronal metabolism, but not hippocampal volume. Conversely, decreased stride length is associated with smaller hippocampal volumes, but not hippocampal neurochemistry. Distinct neurobiological hippocampal substrates may support decreased stride length and increased stride length variability in older adults.
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Affiliation(s)
- Molly E Zimmerman
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1165 Morris Park Avenue, Room 343, Bronx, NY 10461, USA.
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Sung YH, Park KH, Lee YB, Park HM, Shin DJ, Park JS, Oh MS, Ma HI, Yu KH, Kang SY, Kim YJ, Lee BC. Midbrain atrophy in subcortical ischemic vascular dementia. J Neurol 2009; 256:1997-2002. [DOI: 10.1007/s00415-009-5226-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 04/03/2009] [Accepted: 04/27/2009] [Indexed: 11/28/2022]
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Kumagami H, Saino Y, Baba A, Fujiyama D, Takasaki K, Takahashi H. Subjective visual vertical test in patients with chronic dizziness without abnormal findings in routine vestibular function tests. Acta Otolaryngol 2009:46-9. [PMID: 19848239 DOI: 10.1080/00016480902926456] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONCLUSION The subjective visual vertical (SVV) test can detect abnormality of the otolithic organs and the graviceptive pathways present in a considerable number of patients having dizziness but presenting no abnormal findings in conventional vestibular function tests. OBJECTIVE To evaluate whether the SVV test can detect dysfunction of the otolithic organs and perception of gravity in patients with dizziness having no abnormal finding on routine tests for the vestibular system. PATIENTS AND METHODS Forty-four patients who complained of chronic dizziness but had no abnormal finding on routine tests for vestibular system and on brain MRI studies were selected between 2004 and 2006. SVV tests were performed on these patients. Patients with chronic dizziness caused by apparent psychogenic disorders, such as depression, were excluded. RESULTS Among the 44 patients, 3 showed abnormal tilts of SVV. The latter three patients had deep white matter hyperintensities on their MRI, probably due to aging.
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Brain regional lesion burden and impaired mobility in the elderly. Neurobiol Aging 2009; 32:646-54. [PMID: 19428145 DOI: 10.1016/j.neurobiolaging.2009.04.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 04/02/2009] [Accepted: 04/12/2009] [Indexed: 11/20/2022]
Abstract
This study investigated the relationship of brain white matter (WM) lesions affecting specific neural networks with decreased mobility in ninety-nine healthy community-dwelling subjects ≥75 years old prospectively enrolled by age and mobility status. We assessed lesion burden in the genu, body and splenium of corpus callosum; anterior, superior and posterior corona radiata; anterior and posterior limbs of internal capsule; corticospinal tract; and superior longitudinal fasciculus. Burden in the splenium of corpus callosum (SCC) demonstrated the highest correlation particularly with walking speed (r=0.4, p<10(-4)), and in logistic regression it was the best regional predictor of low mobility performance. We also found that independent of mobility, corona radiata has the largest lesion burden with anterior (ACR) and posterior (PCR) aspects being the most frequently affected. The results suggest that compromised inter-hemispheric integration of visuospatial information through the SCC plays an important role in mobility impairment in the elderly. The relatively high lesion susceptibility of ACR and PCR in all subjects may obscure the importance of these lesions in mobility impairment.
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Franch O, Calandre L, Alvarez-Linera J, Louis ED, Bermejo-Pareja F, Benito-León J. Gait disorders of unknown cause in the elderly: Clinical and MRI findings. J Neurol Sci 2009; 280:84-6. [PMID: 19251276 DOI: 10.1016/j.jns.2009.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 02/03/2009] [Accepted: 02/05/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND Disequilibrium of unknown cause in older people has been associated with white matter lesions on neuroimaging studies. OBJECTIVE To investigate the relationship between gait and balance problems in the elderly, white matter hyperintensities, and vascular risk factors. METHODS We studied clinical and neuroimaging features in 30 people older than 65 years of age with gait disorders of unknown cause and 30 age- and sex-matched controls. Patients and controls underwent the same extensive quantitative test battery. White matter lesions on MRI scans were graded in different brain regions. RESULTS History of hypertension was more common among patients than controls (60% vs. 27%, p=0.012). On all scales, patients with gait disorders scored worse than controls. The frequency of white matter lesions was significantly higher in patients than in controls (p<0.001). In a multivariate logistic regression analysis in which diagnosis (patient vs. control) was the dependent variable, there was an association between diagnosis and white matter signal hyperintensity score (p<0.001) and history of hypertension (p=0.039). CONCLUSIONS Gait disorders of unknown cause in older people are associated both with white matter lesions on MRI scans and with history of hypertension.
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Affiliation(s)
- Oriol Franch
- Department of Neurology, Hospital Ruber Internacional, Madrid, Spain.
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Carotid Artery Abnormalities and Leukoaraiosis in Elderly Patients: Evaluation with MDCT. AJR Am J Roentgenol 2009; 192:W63-70. [DOI: 10.2214/ajr.07.3566] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Lee SJ, Kim JS, Lee KS, An JY, Kim W, Kim YI, Kim BS, Jung SL. The severity of leukoaraiosis correlates with the clinical phenotype of Parkinson's disease. Arch Gerontol Geriatr 2008; 49:255-259. [PMID: 18977043 DOI: 10.1016/j.archger.2008.09.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 09/07/2008] [Accepted: 09/11/2008] [Indexed: 11/19/2022]
Abstract
The impact of leukoaraiosis on Parkinson's disease (PD) has not been completely explained. We evaluated 141 patients with PD to assess the role of leukoaraiosis and determined its influence on the clinical phenotype of PD. Clinical assessments during off medication and leukoaraiosis grading were performed according to the atherosclerosis risk in communities (ARIC) study. Patients were grouped into two phenotypes, tremor or postural instability and gait difficulty (PIGD)-dominant groups. Associations between the age at onset, gender, disease duration, cardiovascular risk factors, leukoaraiosis grade and the disease phenotype were analyzed. In addition, the role of the leukoaraiosis grade in relationship to the parkinsonian motor handicaps was evaluated. The leukoaraiosis correlated with the severity of the clinical symptoms of PD as measured by the United Parkinson's disease rating scale (UPDRS) scores and the Hoehn and Yahr (H + Y) stage. There were significant correlations observed between the leukoaraiosis grade and specific motor handicaps especially those with axial symptoms. Multivariate logistic regression analysis showed that the leukoaraiosis grade was independently associated with the PIGD motor phenotype of PD. The leukoaraiosis grade was independently associated with the PIGD motor phenotype of PD; this might be explained by the affects on nondopaminergic subcortical pathways. These results have implications for clinical management of PD with regard to the control of vascular risk factors.
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Affiliation(s)
- Seung-Jae Lee
- Department of Neurology, The Catholic University of Korea, Kangnam St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea
| | - Joong-Seok Kim
- Department of Neurology, The Catholic University of Korea, Kangnam St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea.
| | - Kwang-Soo Lee
- Department of Neurology, The Catholic University of Korea, Kangnam St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea
| | - Jae-Young An
- Department of Neurology, The Catholic University of Korea, Kangnam St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea
| | - Woojun Kim
- Department of Neurology, The Catholic University of Korea, Kangnam St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea
| | - Yeong-In Kim
- Department of Neurology, The Catholic University of Korea, Kangnam St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea
| | - Bum-Soo Kim
- Department of Radiology, The Catholic University of Korea, Kangnam St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea
| | - So-Lyung Jung
- Department of Radiology, The Catholic University of Korea, Kangnam St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea
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Naritomi H. [Chronic dizziness in elderly people: its clinical characteristics and magneto-encephalographic findings]. Rinsho Shinkeigaku 2008; 48:393-400. [PMID: 18616149 DOI: 10.5692/clinicalneurol.48.393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Many elderly people complain dizziness which may continue occasionally for months or years. According to epidemiological studies, 25-29% of subjects with more than 60 years of age have the experience of dizziness. Dizziness occurs most commonly during head positional changes or walking. Clinical studies have indicated that causes of dizziness are nonspecific and multi-factorial; cerebrovascular diseases, cervical spondylosis, depressive state, poor vision, orthostatic hypotension, whiplash injury, or low cerebrospinal fluid syndrome may play a role in the development of dizziness. Patients with dizziness commonly have neck/shoulder pain, insomnia, left-right imbalance of visual acuity, scoliosis, white matter lesions on head MRI. Little, however, has yet been known as to how these symptoms and radiological findings are related to mechanisms of dizziness. During the last several years, we performed cerebral functional studies using auditory-evoked magneto-encephalography (MEG) in elderly people with chronic dizziness. Two types of functional abnormalities were found in dizziness patients. One is a rotational abnormality of MEG signals at the temporal cortex (Type A) which can be detected by current arrow mapping analysis. This abnormality is similar to that detected by non-evoked MEG in temporal lobe epilepsy patients. In patients with Type A abnormality, administration of anticonvulsants brought about dramatic improvement of dizziness in association with disappearance of rotational abnormalities. The other is abnormal prolongation of interhemispheric neural conduction time (INCT) between the left and right temporal cortices (Type B) which can be estimated from the difference of left and right N100 m peak latencies. The INCT was found to be prolonged correlating with the grade of white matter lesions on MRI. The INCT also seems to be prolonged by lack of sleep. Patients with Type B abnormality commonly have the asymmetry of body, such as left-right imbalance of visual acuity, left-right neck pain, or remarkable scoliosis, in association with insomnia and/or depressive state. According to the study of Penfield, dizziness or vertigo is manifested by stimulation of upper temporal cortex and lower parietal cortex. Mechanisms of dizziness can be hypothecated on the basis of MEG findings as follows: Presumably, there are head-position recognizing (HPR) centers in the left and right cerebral hemispheres. The HPR centers may correspond to the vestibular cortex or the combined system of vestibular, visual and somatosensory cortices. The HPR centers in two hemispheres are receiving head-position signals from vestibular, visual and somatosensory corices and are readjusting the dissociation of information which may exist between each other through rapid interhemispheric neural conduction. In patients with Type A abnormality, dizziness may be caused by abnormal neuronal excitements in left or right HPR center. In patients with Type B abnormalities, dizziness may be caused by the combined factors, one the abnormal prolongation of INCT between left and right HPR centers and the other the large dissociation of head position signals between the left and right HPR centers due to the body asymmetry, such as scoliosis or left-right neck pain imbalance.
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Affiliation(s)
- Hiroaki Naritomi
- Department of Cerebrovascular Medicine, National Cardiovascular Center
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Sparto PJ, Aizenstein HJ, Vanswearingen JM, Rosano C, Perera S, Studenski SA, Furman JM, Redfern MS. Delays in auditory-cued step initiation are related to increased volume of white matter hyperintensities in older adults. Exp Brain Res 2008; 188:633-40. [PMID: 18545989 DOI: 10.1007/s00221-008-1443-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 05/25/2008] [Indexed: 11/28/2022]
Abstract
An increased volume of white matter hyperintensities (WMH) on MRI has been associated with mobility impairments in older adults. The objective of this preliminary study was to investigate the relationship between the volume of WMH and the delays in auditory-cued step initiation. Eight subjects aged 75-83 years participated. The WMH volume in the corticospinal tracts and anterior thalamic radiations were summed. Subjects performed an auditory-cued stepping task that included two simple reaction time (SRT) trials and three choice reaction time (CRT) trials. SRT trials required subjects to step as quickly as possible with the right foot from a symmetric standing position to a single target position in response to an auditory stimulus. For the CRT trials, subjects stepped as quickly as possible to one of two possible locations, depending on the auditory stimulus. The time from the stimulus onset to the reaction time of the anticipatory postural adjustment (APA(RT)) and liftoff (LO) of the right foot was computed for each stimulus. The mean APA(RT) and LO were greater for the CRT steps compared with the SRT steps to the same location. Increases in WMH were significantly associated with larger APA(RT) and LO during both SRT and CRT for both target locations. These data suggest that increased volume of WMH is associated with greater central processing time during voluntary step initiation, and highlight a possible mechanism that can help to explain how damage to white matter tracts affects mobility in older adults.
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Affiliation(s)
- Patrick J Sparto
- Department of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260, USA.
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Taaffe DR, Irie F, Masaki KH, Abbott RD, Petrovitch H, Ross GW, White LR. Physical Activity, Physical Function, and Incident Dementia in Elderly Men: The Honolulu-Asia Aging Study. J Gerontol A Biol Sci Med Sci 2008; 63:529-35. [DOI: 10.1093/gerona/63.5.529] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ohmine T, Miwa Y, Yao H, Yuzuriha T, Takashima Y, Uchino A, Takahashi-Yanaga F, Morimoto S, Maehara Y, Sasaguri T. Association between arterial stiffness and cerebral white matter lesions in community-dwelling elderly subjects. Hypertens Res 2008; 31:75-81. [PMID: 18360021 DOI: 10.1291/hypres.31.75] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The presence of cerebral white matter lesions (WMLs) on MRI is suggested to be a predictive factor for vascular dementia and stroke. To investigate the relationship between arterial stiffness and WMLs, we performed brain MRI to evaluate the presence of two subtypes of WML-periventricular hyperintensities (PVH) and deep white matter lesions (DWML)-and furthermore, determined the brachial-ankle pulse wave velocity (ba-PWV) as a marker of arterial stiffness in 132 elderly asymptomatic subjects (49 men and 83 women, 70.3+/-9.0 years). PVH and DWML were observed in 41 (31.0%) and 53 (40.2%) subjects, respectively. The ba-PWV values were significantly greater in subjects with PVH than in those without. DWML also tended to be associated with ba-PWV, but the correlation was not statistically significant. In multiple logistic regression analysis, age and decreased DBP were independently associated with PVH. ba-PWV was also detected as an independent factor for the appearance of PVH (adjusted odds ratio: 2.84, p=0.015) but not DWML. These results indicate that the increase in arterial stiffness contributes to the pathogenesis of PVH rather than DWML. Although further study is needed to clarify the difference between WML subtypes, our study suggests that the measurement of ba-PWV is a simple and useful tool for detecting cerebral arterial dysfunction.
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Affiliation(s)
- Takahiro Ohmine
- Department of Clinical Pharmacology, Graduate School of Medical Sciences, Kyushu University, Fuuoka, Japan
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Rosano C, Aizenstein HJ, Studenski S, Newman AB. A regions-of-interest volumetric analysis of mobility limitations in community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2007; 62:1048-55. [PMID: 17895446 DOI: 10.1093/gerona/62.9.1048] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In community-dwelling older adults, greater mobility impairment is associated with greater burden of diffuse brain structural abnormalities, such as higher white matter hyperintensities. This study examined the association between gray matter volumes of regions related to motor control, gait, and balance and whether this association is independent of burden of white matter hyperintensities. METHODS A random sample of 327 participants of the Cardiovascular Health Study (78.3 +/- 4.1 years old, 57% women) contributed brain magnetic resonance imaging (MRI) and mobility data. A brain imaging automated method measured gray matter volume in cerebellum, basal ganglia, and prefrontal and parietal cortex in both hemispheres. Gait speed was measured while walking 15 feet at usual pace. Standing balance was assessed by timing tandem stance. Associations between each region's volume and gait speed or balance were measured before and after adjustment for demographics, head size, cardiovascular risk factors, and 0-9 grading scores of white matter hyperintensities. RESULTS Smaller left cerebellum and left prefrontal regions were associated with slower gait, independently of covariates and of white matter hyperintensities. Smaller right putamen, right posterior superior parietal cortex, and both left and right cerebellum were associated with balance difficulty, independently of covariates and white matter hyperintensities. CONCLUSIONS Smaller gray matter volumes in regions crucial for motor control are associated with slower gait and poorer balance, and the association appears to be independent of other diffuse brain abnormalities such as white matter hyperintensities.
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Affiliation(s)
- Caterina Rosano
- School of Public Health, Department of Epidemiology, University of Pittsburgh, Pennsylvania, USA.
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Abstract
Higher level gait disorders are common in the elderly. The pathophysiology of these gait disorders is poorly understood, and the nomenclature used to describe them is confusing and the subject of ongoing debate. It is suggested that higher level gait disorders can be explained in terms of breakdown in the organization of equilibrium and locomotion.
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Affiliation(s)
- Philip D Thompson
- University Department of Medicine, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia.
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Murai N, Oda N, Hori I, Shabana M, Kurozawa Y, Funabiki K. The relationship between cerebral T2 hyperintensity and fixation suppression of vestibulo-ocular reflex in elderly patients with dysequilibrium symptoms. Auris Nasus Larynx 2007; 34:165-71. [PMID: 17182204 DOI: 10.1016/j.anl.2006.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Revised: 09/11/2006] [Accepted: 09/19/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the relationship between cerebral T2 hyperintensity on MRI and visual suppression of vestibulo-ocular reflex (VOR) in elderly patients with dysequilibrium symptoms. METHODS Eighty-nine elderly patients with no MRI abnormalities in the infratentorial region aged 60-89 years complaining dysequilibrium symptoms were studied. Cases with whom a definitive diagnosis of peripheral or central disease could be established were not included. T2 hyperintense lesions in the cerebrum: basal ganglia, subcortical white matter and periventricular white matter were evaluated. VOR in darkness and fixation-suppressed VOR using pseudo-sinusoidal rotation stimuli were recorded to calculate visual suppression rate. Correlation between visual suppression rate and semi-quantitative scores for severity of T2 hyperintensity in the cerebrum was investigated. RESULTS Patients with T2 hyperintensity in the cerebrum exhibited significantly lower visual suppression rate than those without lesions in the cerebrum. Multiple regression analysis showed that visual suppression rate was significantly and negatively correlated with severity of lesions in the basal ganglia, but not with patient age, severity of subcortical white matter lesions, or that of periventricular white matter lesions. CONCLUSIONS In elderly patients with dizziness with a non-specific history and otoneurological findings, fixation suppression of vestibular nystagmus was associated with T2 hyperintensities in the basal ganglia.
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Affiliation(s)
- Norihiko Murai
- Department of Otolaryngology, Kyoto-Katsura Hospital, Yamada-Hirao cho 17, Nisigyou ku, Kyoto 615-8256, Japan.
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Inzitari M, Pozzi C, Rinaldi LA, Masotti G, Marchionni N, Di Bari M. Cognitive and functional impairment in hypertensive brain microangiopathy. J Neurol Sci 2007; 257:166-73. [PMID: 17350043 DOI: 10.1016/j.jns.2007.01.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Brain microangiopathy, whose neuroimaging expression is represented by age-related white matter changes (ARWMC), is largely due to hypertension and it is, in turn, responsible for geriatric syndromes, including decline in cognitive, functional and motor/gait abilities. This review analyzes the link between hypertension and ARWMC, as well as the complex relationships between ARWMC and cognitive impairment, executive dysfunction, and movement/gait abnormalities. The available evidence supports the hypothesis that these functional consequences of ARWMC are responsible for substantial disability in the elderly. Thus, adequate treatment of hypertension may represent a feasible way to reduce the burden of disability in late life.
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Affiliation(s)
- Marco Inzitari
- Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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