Regional White Matter Lesions Predict Falls in Patients With Amnestic Mild Cognitive Impairment and Alzheimer's Disease

Ogama, Noriko; Sakurai, Takashi; Shimizu, Atsuya; Toba, Kenji

doi:10.1016/j.jamda.2013.11.004

Cited by 71 publications

(68 citation statements)

References 34 publications

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“…The evaluation of WML was based on the degree of severity according to Fazekas' criteria (Fazekas et al 1993). Recent studies that used quantitative assessment of WML and a regional analysis have also been conducted (Bolandzadeh et al 2014;Ogama et al 2014). Quantitative assessments of WML and consideration of their regions in further studies may help to enhance our findings.…”

Section: Discussionmentioning

confidence: 89%

Effects of white matter lesions on trunk stability during dual-task walking among older adults with mild cognitive impairment

Doi¹,

Shimada

Makizako

et al. 2015

AGE

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The linkage between gait and cognition has been shown in cases of white matter lesion (WML) that affect gait in older adults. Dual-task walking is believed to be cognitively demanding and to alter trunk movement, and gait impairment in people with mild cognitive impairment (MCI) is highlighted under this condition. However, the association between dual-task walking and structural changes in the brain, particularly with WML, in people with MCI is still unclear. The aim of this study was to examine the association between trunk stability during dual-task walking and WML in 560 older adults with MCI. We measured magnetic resonance imaging (MRI) and gait variables. Gait variables included harmonic ratio in vertical, mediolateral, and anteroposterior directions, analyzed using a tri-axial accelerometer attached to the lower trunk. Walking conditions were normal walking and dual-task walking (counting backwards while walking) conditions. Demographical data and brain atrophy were measured as covariates. Subjects were classified into non-severe WML (n=451, mean age=73.2 years) and severe WML (n=109, mean age=75.9 years) groups. Linear mixedeffects model analysis controlled for covariates showed dual-task-related changes in all harmonic ratios associated with WML (p<0.05). Even after adjustment for executive function, harmonic ratio in the mediolateral direction was significantly associated with WML (p<0.05). Our findings revealed that WMLs were associated with trunk stability in dual-task walking. Further studies are required to investigate the neural basis for deficits in gait ability among MCI subjects.

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Section: Discussionmentioning

confidence: 89%

Effects of white matter lesions on trunk stability during dual-task walking among older adults with mild cognitive impairment

Doi¹,

Shimada

Makizako

et al. 2015

AGE

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“…45e50 Although in general falls are considered to be due to either environmental or intrinsic factors, such as sarcopenia, neuropathy, or vision problems, it is clear that central factors also play a role, with the fall rate being very high in persons with dementia. 51,52 New-onset falls are a common harbinger of delirium. 53e57 Approximately a third of falls in older persons are associated with syncope.…”

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confidence: 99%

Gait, Falls, and Dementia

Morley

2016

Journal of the American Medical Directors Association

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“…WMH is associated with various geriatric conditions, 1 and regional WMH has specific effects on cognitive impairment, gait and lower urinary tract symptoms. [2][3][4] To measure WMH, visual rating and volumetric analysis using a computer program have been used. Volumetric measurement of WMH is more sensitive and accurate than visual rating, although the former requires specific laboratory instruments to analyze WMH.…”

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confidence: 99%

“…For visual rating, we used the Fazekas scale, 6 a scale used in the Rotterdam scan study (Rotterdam scale) 7 and our new scale, which is a modified version of the Rotterdam scale (modified Rotterdam scale). 2,3 The Fazekas scale is a simple classification of PVH (grade 0-3), whereas the Rotterdam scale and modified Rotterdam scale are semiquantitative methods. PVH in the Rotterdam scale is visually rated into four grades at frontal caps, bands and occipital caps.…”

mentioning

confidence: 99%

“…5 Recently, specific impacts of frontal WMH have been reported. 3,4 Not only the overall presence of WMH in the brain, but also the size and local distribution of WMH might directly cause several clinical symptoms. The modified Rotterdam scale showed the strongest association with frontal WMH/IC, which implies it is a more useful index than the other visual rating scales.…”

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confidence: 99%

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Validation of a simple and reliable visual rating scale of white matter hyperintensity comparable with computer‐based volumetric analysis

Ogama

Saji²,

Niida

et al. 2015

Geriatrics Gerontology Int

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White matter hyperintensity (WMH), which is detected as hyperintense signals on T2-weighted images of brain magnetic resonance imaging (MRI), is a common finding in the aging brain. WMH is associated with various geriatric conditions, 1 and regional WMH has specific effects on cognitive impairment, gait and lower urinary tract symptoms.2-4 To measure WMH, visual rating and volumetric analysis using a computer program have been used. Volumetric measurement of WMH is more sensitive and accurate than visual rating, although the former requires specific laboratory instruments to analyze WMH. Visual rating is timeconsuming, and the results often vary among raters. Because physicians have to evaluate longitudinal changes in WMH in patients during a limited consultation time, an easier and more reliable method of visual assessment is required. WMH can be divided into two parts; periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH). Previous studies suggested that PVH and DWMH largely share common pathological characteristics.5 Automatic segmentation of WMH mostly recognized DWMH in continuity with PVH, and therefore the volume of DWMH is much smaller.4 Thus, we hypothesized that semiquantitative analysis of PVH could predict total WMH volume. The purpose of the present study was to validate the accuracy of our newly developed visual rating scale for global and regional analysis of WMH. Comparison with conventional methods was carried out by referencing computational volumetric analysis.The participants were 460 patients (318 women) aged 65-85 years; 69 diagnosed with amnestic mild cognitive impairment and 391 with Alzheimer's disease. Clinical data were obtained from the Biobank of National Center for Geriatrics and Gerontology, which collects clinical data for research. All participants underwent brain MRI. The protocol of brain MRI is described elsewhere. 4 WMH on brain MRI was evaluated by both visual and computational volumetric analysis. For visual rating, we used the Fazekas scale, 6 a scale used in the Rotterdam scan study (Rotterdam scale) 7 and our new scale, which is a modified version of the Rotterdam scale (modified Rotterdam scale).2,3 The Fazekas scale is a simple classification of PVH (grade 0-3), whereas the Rotterdam scale and modified Rotterdam scale are semiquantitative methods. PVH in the Rotterdam scale is visually rated into four grades at frontal caps, bands and occipital caps. The total score was calculated by adding the three region-specific scores.7 In contrast, the modified Rotterdam scale rates PVH as five grades with definitive ranges of WMH dimension from the edge of ventricles at the identical regions of PVH, but separately in the left and right hemisphere. The degree of PVH was calculated by adding up the scores of six separate regions.

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Regional White Matter Lesions Predict Falls in Patients With Amnestic Mild Cognitive Impairment and Alzheimer's Disease

Cited by 71 publications

References 34 publications

Effects of white matter lesions on trunk stability during dual-task walking among older adults with mild cognitive impairment

Effects of white matter lesions on trunk stability during dual-task walking among older adults with mild cognitive impairment

Gait, Falls, and Dementia

Validation of a simple and reliable visual rating scale of white matter hyperintensity comparable with computer‐based volumetric analysis

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