Accrual of MRI white matter abnormalities in elderly with normal and impaired mobility

Wolfson, Leslie; Wei, Xing‐Chang; Hall, Charles B.; Panzer, Victoria; Wakefield, Dorothy; Benson, Randall R.; Schmidt, Julia A.; Warfield, Simon K.; Guttmann, Charles R.G.

doi:10.1016/j.jns.2004.12.017

Cited by 68 publications

(78 citation statements)

References 23 publications

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“…The relationship between postural instability and PVH has been investigated in several studies, [10][11][12][13][14][15][16] with results consistently supporting the positive relationship between the 2 parameters; however, few studies have been concluded on lacunar infarction, and even fewer on microbleeds. One strength of our present study was, therefore, the concomitant evaluation of cSVDs and findings of a positive association of postural instability with lacunar infarction and microbleeds.…”

Section: Discussionmentioning

confidence: 97%

“…10 Reduced physical activity, which includes postural instability as a component, has been suggested to be associated with cSVD in observational analysis 11,12 and in longitudinal studies. 13,14 Although the study population in these previous studies numbered <700 individuals, a large-scale longitudinal study (the Cardiovascular Health Study) provided further support for the relationship between physical inactivity and subclinical brain MRI abnormalities in community-dwelling adults aged ≥65 years. 15,16 However, these studies were based on elderly subjects, with no results available for middle-aged individuals, despite the fact that cSVD can be detected in middle age.…”

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confidence: 96%

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Association of Postural Instability With Asymptomatic Cerebrovascular Damage and Cognitive Decline

Tabara

Okada

O’Hara

et al. 2015

Stroke

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Background and Purpose-Asymptomatic cerebral small-vessel disease (cSVD) in elderly individuals are potent risk factors for stroke. In addition to common clinical risk factors, postural instability has been postulated to be associated with cSVD in older frail patients. Here, we conducted a cross-sectional study to understand the possible link between postural instability and asymptomatic cSVD further, namely periventricular hyperintensity, lacunar infarction, and microbleeds, as well as cognitive function, in a middle-aged to elderly general population (n=1387). Methods-Postural instability was assessed based on one-leg standing time (OLST) and posturography findings. cSVD was evaluated by brain magnetic resonance imaging. Mild cognitive impairment was assessed using a computer-based questionnaire, and carotid intima-media thickness as an index of atherosclerosis was measured via ultrasonography. Results-Frequency of short OLST, in particular <20 s, increased linearly with severity of cSVD (lacunar infarction lesion: none, 9.7%; 1, 16.0%; >2, 34.5%; microbleeds lesion: none, 10.1%; 1, 15.3%; >2, 30.0%; periventricular hyperintensity grade: 0, 5.7%; 1, 11.5%; >2, 23.7%). The association of short OLST with lacunar infarction and microbleeds but not periventricular hyperintensity remained significant even after adjustment for possible covariates (lacunar infarction, P=0.009; microbleeds, P=0.003; periventricular hyperintensity, P=0.601). In contrast, no significant association was found between posturographic parameters and cSVD, whereas these parameters were linearly associated with OLST. Short OLST was also significantly associated with reduced cognitive function independent of covariates, including cSVD (P=0.002). Conclusions-Postural instability was found to be associated with early pathological changes in the brain and functional decline, even in apparently healthy subjects. Correspondence to Yasuharu Tabara, PhD, Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Shogoinkawaracho 53, Sakyoku, Kyoto 606-8507, Japan. E-mail tabara@genome.med.kyoto-u.ac.jp © 2014 American Heart Association, Inc. 16 has examined the association between lacunar infarction and postural instability, and no data are available on the association between microbleeds and postural instability, despite individuals with lacunar infarction and PVH being frequently complicated with microbleeds. 17Here, we conducted a cross-sectional study to understand the possible link between postural instability and asymptomatic cSVDs further-namely, PVH, lacunar infarction, and microbleeds-in a middle-aged to elderly general population. As we previously showed that individuals with mild cognitive impairment, particularly those with Alzheimer disease, were prone to instability while standing on 1 leg, 18 we attempted to gather more evidence in the present study. Methods Study SubjectsThe study subjects were 1387 apparently healthy middle-aged to elderly individuals who were consecutive participants in the medical checkup program a...

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Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 96%

Association of Postural Instability With Asymptomatic Cerebrovascular Damage and Cognitive Decline

Tabara

Okada

O’Hara

et al. 2015

Stroke

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“…Age is the most powerful and consistent predictor of WMH severity across all and any populations studied systematically since its evolvement as a marker and manifestation of diffuse cerebrovascular disease and a risk factor for stroke, cognitive impairment, and functional disability. 2,24,4 This indicator of effect consistency by age on WMHV is especially significant considering the lack of direct comparison studies of WMH burden between general populations and patients with cerebrovascular disease. An average WMHV reported for stroke-free participants of the Framingham Offspring Study (mean age 58 6 10 years) was 0.05 cm 3 ; 25 however, virtually no data exist with regard to WMHV in the young with exception of patients with early-onset stroke (mean age 46.1 6 7.5 years) with average WMHV reported at 0.9 cm 3 .…”

Section: -15mentioning

confidence: 99%

Determinants of white matter hyperintensity burden in patients with Fabry disease

et al. 2016

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Objective: Using a semiautomated volumetric MRI assessment method, we aimed to identify determinants of white matter hyperintensity (WMH) burden in patients with Fabry disease (FD).Methods: Patients with confirmed FD and brain MRI available for this analysis were eligible for this protocol after written consent. Clinical characteristics were abstracted from medical records. T2 fluid-attenuated inversion recovery MRI were transferred in electronic format and analyzed for WMH volume (WMHV) using a validated, computer-assisted method. WMHV was normalized for head size (nWMHV) and natural log-transformed (lnWMHV) for univariate and multivariate linear regression analyses. Level of significance was set at p , 0.05 for all analyses.Results: Of 223 patients with FD and WMHV analyzed, 132 (59%) were female. Mean age at MRI was 39.2 6 14.9 (range 9.6-72.7) years, and 136 (61%) patients received enzyme replacement therapy prior to enrollment. Median nWMHV was 2. Cerebrovascular disease, including stroke, is a significant source of morbidity in patients with Fabry disease (FD), an X-linked lysosomal storage disorder characterized by reduced activity of the enzyme a-galactosidase A.1 Burden of MRI-detectable white matter hyperintensity (WMH) has been linked to risk of stroke, 2 poor poststroke outcome, 3 and functional disability in aging adults 4 ; however, there are no systematic studies of WMH in patients with FD. Previously, nonquantitative studies have documented WMH lesions in adults with FD, 5,6 pediatric patients, 7 and the Fabry Outcome Survey registry participants. 8 A comparison of CT and MRI findings in patients with FD suggested the potential utility of a rating scale in this population. 9 The recently published Stroke in Young Fabry Patients (SIFAP1) study 10 showed detailed neuroimaging MRI characteristics including WMH assessed using a validated ordinal scale 11,12 ; however, it failed to identify any FD-specific MRI characteristics.

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“…This suggests that subjects with mobility impairment have accelerated, disease-related WMSA accrual [28] .…”

Section: Gait Disordermentioning

confidence: 98%

The clinical manifestations and pathophysiology of cerebral small vessel disease

Zhang

Wang

2010

Neurosci. Bull.

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Small vessel disease (SVD) is responsible for brain chronic circular disorder, and accounts for 20%-30% cases of ischemic stroke as well as cerebral hemorrhage, and to a great extent, encephalopathy. Binswanger's disease and multiple small strokes, which are common in older people, are also closely associated with SVD. These disorders often cause decline in cognition, vascular dementia, impairment in gait and balance, mood depression, and urinary incontinence, and often brings great social and economic burdens. SVD-related encephalopathy increases the incidences of fall, disability and death in elderly people. With the aging of the society, more attention should be paid to the importance of early diagnosis and prophylactic treatment of SVD. Here the clinical manifestations and pathophysiology of SVD are reviewed.

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Accrual of MRI white matter abnormalities in elderly with normal and impaired mobility

Cited by 68 publications

References 23 publications

Association of Postural Instability With Asymptomatic Cerebrovascular Damage and Cognitive Decline

Association of Postural Instability With Asymptomatic Cerebrovascular Damage and Cognitive Decline

Determinants of white matter hyperintensity burden in patients with Fabry disease

The clinical manifestations and pathophysiology of cerebral small vessel disease

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