Inzitari Domenico, Simoni Michela, Pracucci Giovanni, Poggesi Anna, Basile Anna Maria, Chabriat Hugues, Erkinjuntti Timo, Fazekas Franz, Ferro José M, Hennerici Michael, Langhorne Peter, O'Brien John, Barkhof Frederik, Visser Marieke C, Wahlund Lars-Olof, Waldemar Gunhild, Wallin Anders, Pantoni Leonardo
Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy.
Arch Intern Med. 2007 Jan 8;167(1):81-8. doi: 10.1001/archinte.167.1.81.
Age-related white matter changes (ARWMCs), frequently detected on neuroimaging, are associated with motor, cognitive, urinary, and mood disorders. The LADIS (LeukoAraiosis and DISability) Study primarily aims to assess ARWMCs as a determinant of global functional decline in the elderly population.
We enrolled 639 patients (mean age, 74.1 +/- 5.0 years; 45.1% male) referred for nondisabling complaints, who had ARWMCs detected on brain magnetic resonance imaging (MRI) of mild, moderate, or severe grade according to the Fazekas scale. At the 1-year follow-up, 619 were reassessed using the Instrumental Activities of Daily Living (IADL) scale. Of these, 506 were totally independent at baseline, and 113 were impaired in only 1 item of the IADL scale. We studied the 1-year transition to 2 or more activities limited and selective functional impairments as cofactors of functional decline.
The rate of transition was 9%, 15%, and 26%, in the mild, moderate, and severe ARWMC group, respectively. Comparing the severe with the mild ARWMC groups and adjusting for age and for other predictors of decline, the risk was more than 2-fold higher (odds ratio; 2.38; 95% confidence interval, 1.29-4.38) in patients with 0 or 1 activity limited, and 3-fold higher (odds ratio, 3.02; 95% confidence interval, 1.34-6.78) among patients fully independent at baseline. Both motor and cognitive deterioration predominantly explained the effect of ARWMCs on global functional decline.
Elderly patients who are functionally independent and who have severe ARWMCs are at considerable risk of becoming more dependent in a short period, mostly owing to motor and cognitive deterioration.
与年龄相关的脑白质改变（ARWMCs）在神经影像学检查中经常被发现，与运动、认知、泌尿和情绪障碍有关。LADIS（脑白质疏松症与残疾）研究主要旨在评估ARWMCs作为老年人群整体功能衰退的一个决定因素。
我们纳入了639例因非致残性主诉前来就诊的患者（平均年龄74.1±5.0岁；男性占45.1%），这些患者根据Fazekas量表在脑磁共振成像（MRI）上检测出轻度、中度或重度的ARWMCs。在1年的随访中，使用日常生活工具性活动（IADL）量表对619例患者进行了重新评估。其中，506例在基线时完全独立，113例仅在IADL量表的1项上存在功能受损。我们研究了在1年时间里转变为2项或更多活动受限及选择性功能受损作为功能衰退的辅助因素的情况。
轻度、中度和重度ARWMC组的转变率分别为9%、15%和26%。将重度ARWMC组与轻度ARWMC组进行比较，并对年龄和其他衰退预测因素进行校正后，在0项或1项活动受限的患者中，风险高出2倍多（比值比；2.38；95%置信区间，1.29 - 4.38），在基线时完全独立的患者中，风险高出3倍（比值比，3.02；95%置信区间，1.34 - 6.78）。运动和认知功能恶化主要解释了ARWMCs对整体功能衰退的影响。
功能独立且患有重度ARWMCs的老年患者在短期内有相当大的风险变得更加依赖他人，主要原因是运动和认知功能恶化。
