White Matter Lesions Are Associated With Hospital Admissions Because of Hip-Fractures and Trauma After Ischemic Stroke

Abstract

The Helsinki Stroke Aging Memory (SAM) cohort consists of 1622 consecutive patients with suspected stroke (all Finnish, white) admitted to the Helsinki University Central Hospital between December 1, 1993 and March 30, 1995. Patients without ischemic stroke (n=175), intracerebral (n=229), or subarachnoid (n=69) hemorrhage were Background and Purpose-Cerebral white matter lesions (WMLs), a surrogate for cerebral small-vessel disease, have been shown to be associated with decreasing mobility, gait instability, and falls. The aim of this study was to investigate whether WMLs of the brain are associated with increased incidence of hospital admissions because of any trauma and hip-fractures in a cohort of patients with stroke. Methods-We included 383 consecutive patients aged 55 to 85 years with ischemic stroke admitted to the Helsinki University Central Hospital (The Stroke Aging Memory cohort) with a 12-year follow-up. National register data were reviewed for hip-fractures, other traumatic injuries, survival data, and causes of death. WMLs were rated using MRI and dichotomized as none to mild and moderate to severe. The data were analyzed using Kaplan-Meier plots (log-rank) and a complex Cox multivariable hazards models for multiple cases per subject to assess hazard ratios with their 95% confidence intervals. Results-During the 12-year follow-up, there were more hip-fractures (13.5% versus 6.5%; log-rank, P=0.01) and more hospital admissions because of traumatic injury (22.2% versus 16.7%; log-rank, P=0.04) in the moderate-to-severe than in the none-to-mild WMLs group. In the complex samples, Cox multivariable model adjusting for age, sex, National

Daily Living Activities and Cognition in Aged Patients: Effect of Acute Systemic Diseases and Stroke on Leukoaraiosis

“…While the already reported association of stroke and L-A reportedly impairs DLA and cognition [34-38], curiously very few information exists regarding manifestations of L-A and its possible association with ASD, except only in the case of anemia [39]. Results presented here support the hypothesis that general organic ailments influence the development of L-A, reaching an impairment degree similar to that observed in stroke.…”

Aging with Cerebral Small Vessel Disease and Dizziness: The Importance of Undiagnosed Peripheral Vestibular Disorders

“…The white matter lesions burden positively correlates with age, with a higher prevalence of severe SVD in patients older than 76 years (8). A significant involvement of the brain by SVD is linked with the development of geriatric syndromes (1, 2) and can truly represent a clinical entity able to cause dizziness and falls in the elderly (6, 9). Eye movement control pathways for saccades and pursuit involve ascending and descending fibers between frontal and parietal cortex, basal ganglia, brainstem, and cerebellum (13).…”

“…Although it has been established how SVD contributes to the development of cognitive decline and dementia (3, 4) and falls (5, 6), little is known about SVD as a possible cause of dizziness. White matter hyperintensities on T2-weighted and fluid-attenuated inversion recovery sequences on magnetic resonance imaging (MRI) are the radiological expression of SVD and represent a well-known marker of a higher risk of cerebral, cerebellar, and brainstem stroke (7).…”

Severe Cerebral White Matter Lesions in Ischemic Stroke Patients are Associated with Less Time Spent at Home and Early Institutionalization

“…We have shown that WMLs are associated with hospital admissions because of hip fractures, trauma, and recurrent stroke (11, 12).…”

“…Severe white matter lesions (WMLs), one imaging expression of cerebral small vessel disease, are associated with an increased risk of functional decline, morbidity, and death in independent outpatients and also in acute stroke patients (5)(6)(7). The international Leukoaraiosis and Disability in the Elderly (LADIS) study has shown that severe WMLs more than double the risk of transition from an autonomous to dependent status in a three-year follow-up (8).…”