Baezner H, Blahak C, Poggesi A, Pantoni L, Inzitari D, Chabriat H, Erkinjuntti T, Fazekas F, Ferro J M, Langhorne P, O'Brien J, Scheltens P, Visser M C, Wahlund L O, Waldemar G, Wallin A, Hennerici M G
Mannheim University Hospital, University of Heidelberg, Department of Neurology, Theodor Kutzer Ufer, D-68135 Mannheim, Germany.
Neurology. 2008 Mar 18;70(12):935-42. doi: 10.1212/01.wnl.0000305959.46197.e6.
In the Leukoaraiosis and Disability (LADIS) Study, 11 European centers are evaluating the role of age-related white matter changes (ARWMC) as an independent determinant of the transition to disability in the elderly (65 to 84 years). We aimed at determining the influence of ARWMC on different objective measures of gait and balance.
Six hundred thirty-nine nondisabled individuals were prospectively enrolled and are being followed-up for 3 years. Subjects are graded in three standardized categories of ARWMC (mild, moderate, and severe) according to central MRI reading. Quantitative tests of gait and balance include the Short Physical Performance Battery (SPPB; range: 0 [poor] to 12 [normal]), a timed 8-m walk, and a timed single leg stance test.
In cross-sectional analysis, deficiencies in gait and balance performance were correlated with the severity of ARWMC (SPPB: 10.2 +/- 2.1 in the mild, 9.9 +/- 2.0 in the moderate, 8.9 +/- 2.6 in the severe group; p < 0.001). Walking speed correlated with the severity of ARWMC (1.24 +/- 0.28 m/second in the mild, 1.18 +/- 0.32 m/second in the moderate, and 1.09 +/- 0.31 m/second in the severe group; p < 0.001). Balance was best in individuals with mild ARWMC (single leg stance time: 18.9 +/- 10.8 seconds) compared with moderate and severe ARWMC (16.4 +/- 10.8 and 13.6 +/- 11.2 seconds) (p < 0.001). Physically inactive individuals had a higher risk of a pathologic SPPB score (moderate vs mild ARWMC: odds ratio 1.60, 95% CI 1.02 to 2.52; severe vs mild ARWMC: odds ratio 1.75, 95% CI 1.09 to 2.80).
Our findings support a strong association between the severity of age-related white matter changes and the severity of gait and motor compromise. Physical activity might have the potential to reduce the risk of limitations in mobility.
在白质疏松症与残疾（LADIS）研究中，11个欧洲研究中心正在评估与年龄相关的白质变化（ARWMC）作为老年人（65至84岁）向残疾转变的独立决定因素的作用。我们旨在确定ARWMC对不同步态和平衡客观指标的影响。
前瞻性招募了639名未残疾个体，并对其进行为期3年的随访。根据中央MRI读数，将受试者分为ARWMC的三个标准化类别（轻度、中度和重度）。步态和平衡的定量测试包括简短体能状况量表（SPPB；范围：0[差]至12[正常]）、8米定时步行和定时单腿站立测试。
在横断面分析中，步态和平衡表现的缺陷与ARWMC的严重程度相关（SPPB：轻度组为10.2±2.1，中度组为9.9±2.0，重度组为8.9±2.6；p<0.001）。步行速度与ARWMC的严重程度相关（轻度组为1.24±0.28米/秒，中度组为1.18±0.32米/秒，重度组为1.09±0.31米/秒；p<0.001）。与中度和重度ARWMC（分别为16.4±10.8秒和13.6±11.2秒）相比，轻度ARWMC个体的平衡最佳（单腿站立时间：18.9±10.8秒）（p<0.001）。身体不活动的个体出现病理性SPPB评分的风险更高（中度与轻度ARWMC：比值比1.60，95%可信区间1.02至2.52；重度与轻度ARWMC：比值比1.75，95%可信区间1.09至2.80）。
我们的研究结果支持与年龄相关的白质变化严重程度与步态和运动功能受损严重程度之间存在密切关联。体育活动可能有降低行动受限风险的潜力。
