Baloh Robert W, Ying Sarah H, Jacobson Kathleen M
Department of Neurology, University of California, Los Angeles 90095, USA.
Arch Neurol. 2003 Jun;60(6):835-9. doi: 10.1001/archneur.60.6.835.
To identify the causes of deteriorating gait and balance in normal older people.
We measured visual acuity, vestibulo-ocular responses, pure-tone hearing levels, vibration sense, deep tendon reflexes, and Tinetti gait and balance scores in 59 normal older subjects (mean +/- SD age on entry, 78.5 +/- 3.7 years) followed up at yearly examinations (range, 8-10 years). White matter hyperintensities on magnetic resonance imaging taken in mid follow-up were graded qualitatively and quantitatively.
For each variable except white matter hyperintensities, we calculated a normalized change per year. There was a significant (P<.05) age-related decrease in vestibulo-ocular reflex gain at 0.05 and 0.20 Hz but not at 0.80 Hz, an increase in pure-tone hearing thresholds (at 1, 2, 4, and 8 kHz), a decrease in vibration sense and deep tendon reflexes in the feet, and a decrease in total Tinetti score. However, only changes in vibration sense in the feet and hearing at 1 kHz were significantly correlated (Spearman rank correlation) with the change in Tinetti score. White matter hyperintensities on magnetic resonance imaging had a higher correlation with the yearly change in Tinetti scores.
This longitudinal study showed age-related decreases in vestibular, visual, auditory, and somatosensation in normal older people, but these changes were only weakly correlated with changes in gait and balance. White matter hyperintensities on magnetic resonance imaging were more highly correlated with changes in gait and balance, but all variables together accounted for only about 29% of the measured change in gait and balance.
确定正常老年人步态和平衡能力恶化的原因。
我们对59名正常老年受试者（入组时平均年龄±标准差为78.5±3.7岁）进行了视力、前庭眼反射、纯音听力水平、振动觉、深部腱反射以及Tinetti步态和平衡评分的测量，这些受试者在每年的检查中进行随访（随访时间为8 - 10年）。对随访中期进行的磁共振成像上的白质高信号进行定性和定量分级。
除白质高信号外，我们计算了每个变量每年的标准化变化。在0.05和0.20 Hz频率下，前庭眼反射增益存在显著（P<0.05）的年龄相关性下降，但在0.80 Hz频率下未出现；纯音听力阈值升高（在1、2、4和8 kHz），足部振动觉和深部腱反射下降，Tinetti总分下降。然而，只有足部振动觉变化和1 kHz频率下的听力变化与Tinetti评分变化显著相关（Spearman等级相关性）。磁共振成像上的白质高信号与Tinetti评分的年度变化具有更高的相关性。
这项纵向研究表明，正常老年人的前庭、视觉、听觉和躯体感觉存在年龄相关性下降，但这些变化与步态和平衡变化的相关性较弱。磁共振成像上的白质高信号与步态和平衡变化的相关性更高，但所有变量共同仅占步态和平衡测量变化的约29%。
