Blahak C, Baezner H, Pantoni L, Poggesi A, Chabriat H, Erkinjuntti T, Fazekas F, Ferro J M, Langhorne P, O'Brien J, Visser M C, Wahlund L-O, Waldemar G, Wallin A, Inzitari D, Hennerici M G
Department of Neurology, Universitätsklinikum Mannheim, Theodor-Kutzer Ufer 1-3, D-68167 Mannheim, Germany.
J Neurol Neurosurg Psychiatry. 2009 Jun;80(6):608-13. doi: 10.1136/jnnp.2008.154633. Epub 2009 Feb 9.
Global age related white matter changes (ARWMC) are associated with progressive gait disturbances and falls, hypothesised to result from interruptions of cortico-subcortical circuits controlling balance, posture and locomotion.
The location of ARWMC in a large cohort of elderly non-disabled individuals with reported falls was analysed, using the cross sectional data of the Leukoaraiosis and Disability (LADIS) study. Detailed anatomical distributions of ARWMC assessed by MRI studies were analysed with respect to falls and balance performance.
The severity of global ARWMC was significantly associated with a history of falls in the year prior to study inclusion (22.2% in the mild, 31.6% in the moderate and 37.3% in the severe ARWMC group according to the Fazekas scale; p = 0.002). Analysing the anatomical distribution of ARWMC, using the semiquantitative Scheltens scale, in multivariate analysis, periventricular (p = 0.006) and frontal deep (p = 0.033) ARWMC were independently associated with falls. Furthermore, logistic regression identified frontal deep (p = 0.003) ARWMC, but not basal ganglia and infratentorial hyperintensities, as significantly associated with balance disturbances.
The association of frontal and periventricular ARWMC with falls supports the hypothesis that interruption of frontal subcortical motor circuits lead to balance disturbances and hence to an increased risk for falls in ARWMC.
全球年龄相关性白质改变（ARWMC）与进行性步态障碍和跌倒有关，据推测是由控制平衡、姿势和运动的皮质-皮质下回路中断所致。
利用白质疏松症与残疾（LADIS）研究的横断面数据，分析了一大群有跌倒报告的非残疾老年人中ARWMC的位置。通过MRI研究评估的ARWMC详细解剖分布与跌倒和平衡表现进行了分析。
根据 Fazekas 量表，研究纳入前一年的跌倒史与全球 ARWMC 的严重程度显著相关（轻度 ARWMC 组为 22.2%，中度为 31.6%，重度为 37.3%；p = 0.002）。在多变量分析中，使用半定量 Scheltens 量表分析 ARWMC 的解剖分布，脑室周围（p = 0.006）和额叶深部（p = 0.033）的 ARWMC 与跌倒独立相关。此外，逻辑回归确定额叶深部（p = 0.003）的 ARWMC 与平衡障碍显著相关，而基底节和幕下高信号则不然。
额叶和脑室周围的 ARWMC 与跌倒之间的关联支持了以下假设：额叶皮质下运动回路的中断会导致平衡障碍，从而增加 ARWMC 患者跌倒的风险。
