Brain white-matter changes in the elderly prone to falling.

Falls and impaired gait are a major source of morbidity in the elderly. Why some elderly become prone to falling is often unclear. We analyzed the gait, equilibrium, and brain computed tomography results of 40 elderly subjects without evidence of neurologic disease known to be associated with falls. Twenty of these subjects were prone to falling and the remaining 20 were nonfalling controls. These two groups were comparable in terms of age and sex (mean age, 83.3 years [SE, 1.7 years]). The group of fallers had significantly worse gait and equilibrium scores and a greater degree of white-matter hypodensity on computed tomography. White-matter hypodensity correlated with impaired gait and equilibrium scores but not with impaired performance on cognitive testing. This study reveals the association of white-matter disease with gait and balance impairment leading to falls in the elderly.

[1]  M Brant-Zawadzki,et al.  MR imaging of the aging brain: patchy white-matter lesions and dementia. , 1985, AJNR. American journal of neuroradiology.

[2]  F. Buonanno,et al.  Comparison of magnetic resonance and roentgen ray computed tomography in dementia. , 1987, Archives of neurology.

[3]  J. Olszewski.  Subcortical arteriosclerotic encephalopathy. Review of the literature on the so-called Binswanger's disease and presentation of two cases. , 1962, World neurology.

[4]  I. Janota.  Dementia, deep white matter damage and hypertension: ‘Binswanger's disease’ , 1981, Psychological Medicine.

[5]  M. Folstein,et al.  Clinical diagnosis of Alzheimer's disease , 1984, Neurology.

[6]  W. Ballinger,et al.  Subcortical arteriosclerotic encephalopathy: CT spectrum and pathologic correlation. , 1986, AJR. American journal of roentgenology.

[7]  L A Saint-Louis,et al.  Periventricular hyperintensity as seen by magnetic resonance: prevalence and significance. , 1986, AJR. American journal of roentgenology.

[8]  T. Jernigan,et al.  White Matter Changes in Cerebral Computed Tomography Related to Aging , 1982, Journal of computer assisted tomography.

[9]  M. Critchley.  On senile disorders of gait, including the so-called senile paraplegia. , 1948, Geriatrics.

[10]  W. Koller,et al.  Senile gait. A distinct neurologic entity. , 1985, Clinics in geriatric medicine.

[11]  M. Gado,et al.  Periventricular white matter lucencies in senile dementia of the Alzheimer type and in normal aging , 1987, Neurology.

[12]  L. Weisberg,et al.  MRI periventricular lesions in adults , 1986, Neurology.

[13]  R. Escourolle,et al.  Leukoencephalopathy in diffuse hemorrhagic cerebral amyloid angiopathy , 1985, Annals of neurology.

[14]  A. Brun,et al.  A white matter disorder in dementia of the Alzheimer type: A pathoanatomical study , 1986, Annals of neurology.

[15]  F. Dubas,et al.  leucoencéphalopathies artériopathiques (17 cas anatomo-cliniques) , 1985 .

[16]  J. Trojanowski,et al.  Brain MR: pathologic correlation with gross and histopathology. 2. Hyperintense white-matter foci in the elderly. , 1988, AJR. American journal of roentgenology.

[17]  M. Ronthal,et al.  Gait disorders among elderly patients. A survey study of 50 patients. , 1983, Archives of neurology.

[18]  Lester M. Wolfson,et al.  Stressing the Postural Response , 1986, Journal of the American Geriatrics Society.

[19]  L. Ketonen,et al.  PREVALENCE OF BINSWANGER'S DISEASE , 1983, The Lancet.

[20]  B. Kendall,et al.  White matter abnormality in cerebral atrophy: clinicoradiological correlations. , 1980, Journal of neurology, neurosurgery, and psychiatry.

[21]  C D Marsden,et al.  Gait disorder of subcortical arteriosclerotic encephalopathy: Binswanger's disease , 1987, Movement disorders : official journal of the Movement Disorder Society.

[22]  I. Sawhney,et al.  Isolated facial palsy in chickenpox. , 1984, Journal of neurology, neurosurgery, and psychiatry.

[23]  Ke-wei Huang,et al.  Binswanger’s Disease: Progressive Subcortical Encephalopathy or Multi-Infarct Dementia? , 1985, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[24]  L. Jacobs,et al.  Subcortical Arteriosclerotic Encephalopathy (Binswanger's Disease): Computed Tomographic, Nuclear Magnetic Resonance, and Clinical Correlations , 1985 .

[25]  J. Masdeu,et al.  Thalamic astasia: Inability to stand after unilateral thalamic lesions , 1988, Annals of neurology.

[26]  M. Roth,et al.  The Association Between Quantitative Measures of Dementia and of Senile Change in the Cerebral Grey Matter of Elderly Subjects , 1968, British Journal of Psychiatry.

[27]  T. Sabin.  Biologic Aspects of Falls and Mobility Limitations in the Elderly , 1982, Journal of the American Geriatrics Society.

[28]  W G Bradley,et al.  Deep white matter infarction: correlation of MR imaging and histopathologic findings. , 1988, Radiology.

[29]  W. Bradley.  Patchy, periventricular white matter lesions in the elderly : common observation during NMR imaging , 1984 .

[30]  S. Baker,et al.  Fall injuries in the elderly. , 1985, Clinics in geriatric medicine.

[31]  C. P. Hughes,et al.  Volumetric measurements of the cerebrospinal fluid spaces in demented subjects and controls. , 1982, Radiology.

[32]  J Marshall,et al.  Subcortical arteriosclerotic encephalopathy: a clinical and radiological investigation. , 1981, Journal of neurology, neurosurgery, and psychiatry.

[33]  R F Spetzler,et al.  Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. I. Correlation with age and cerebrovascular risk factors. , 1986, Stroke.

[34]  V. Hachinski,et al.  Cognitive and neurologic findings in subjects with diffuse white matter lucencies on computed tomographic scan (leuko-araiosis). , 1987, Archives of neurology.

[35]  R F Spetzler,et al.  Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. II. Postmortem pathological correlations. , 1986, Stroke.

[36]  Donald F. Morrison,et al.  Applied linear statistical methods , 1983 .

[37]  V. Haughton,et al.  Neuropsychological test findings in subjects with leukoaraiosis. , 1989, Archives of neurology.

[38]  J. Dereuck.  The cortico-subcortical arterial angio-architecture in the human brain. , 1972 .

[39]  M. Tinetti,et al.  Risk factors for falls among elderly persons living in the community. , 1988, The New England journal of medicine.

[40]  K. Godfrey.  Comparing the Means of Several Groups , 1985, Medical Uses of Statistics.

[41]  James C. Young,et al.  Periventricular White Matter Changes and Dementia: Clinical, Neuropsychological, Radiological, and Pathological Correlation , 1988 .

[42]  L A Hayman,et al.  White-matter lesions in MR imaging of clinically healthy brains of elderly subjects: possible pathologic basis. , 1987, Radiology.

[43]  M. Kornfeld,et al.  Subcortical arteriosclerotic encephalopathy (Binswanger) , 1979, Neurology.

[44]  L. Caplan,et al.  Clinical features of subcortical arteriosclerotic encephalopathy (Binswanger disease) , 1978, Neurology.

[45]  G. Román,et al.  Senile dementia of the Binswanger type. A vascular form of dementia in the elderly. , 1987, JAMA.

[46]  R. Wilson,et al.  Senile gait: Correlation with computed tomographic scans , 1983, Annals of neurology.

[47]  H. Fukasawa,et al.  Diffuse white-matter disease in the geriatric population. A clinical, neuropathological, and CT study. , 1981, Radiology.

[48]  C. Fisher.  Hydrocephalus as a cause of disturbances of gait in the elderly , 1982, Neurology.

[49]  Luc Crevits,et al.  Pathogenesis of Binswanger chronic progressive subcortical encephalopathy , 1980, Neurology.

[50]  M. Kendall.  Rank Correlation Methods , 1949 .

[51]  M. Leon,et al.  Leukoencephalopathy in normal and pathologic aging: 2. MRI of brain lucencies. , 1986, AJNR. American journal of neuroradiology.

[52]  J. Marshall,et al.  Hypoperfusion in the aetiology of subcortical arteriosclerotic encephalopathy (Binswanger type) , 1984, Journal of neurology, neurosurgery, and psychiatry.

[53]  E. Busse,et al.  ALTERATIONS IN NEUROLOGIC STATUS WITH AGE * , 1960 .

[54]  L. Wolfson,et al.  Gait and balance in the elderly. Two functional capacities that link sensory and motor ability to falls. , 1985, Clinics in geriatric medicine.