Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.
Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.
J Am Med Dir Assoc. 2014 Jan;15(1):36-41. doi: 10.1016/j.jamda.2013.11.004.
Preventive strategy for falls in demented elderly is a clinical challenge. From early-stage of Alzheimer's disease (AD), patients show impaired balance and gait. The purpose of this study is to determine whether regional white matter lesions (WMLs) can predict balance/gait disturbance and falls in elderly with amnestic mild cognitive impairment (aMCI) or AD.
Cross-sectional.
Hospital out-patient clinic.
One hundred sixty-three patients diagnosed with aMCI or AD were classified into groups having experienced falls (n = 63) or not (n = 100) in the previous year.
Cognition, depression, behavior and psychological symptoms of dementia, medication, and balance/gait function were evaluated. Regional WMLs were visually analyzed as periventricular hyperintensity in frontal caps, bands, and occipital caps, and as deep white matter hyperintensity in frontal, parietal, temporal, and occipital lobes, basal ganglia, thalamus, and brain stem. Brain atrophy was linearly measured.
The fallers had a greater volume of WMLs and their posture/gait performance tended to be worse than nonfallers. Several WMLs in particular brain regions were closely associated with balance and gait impairment. Besides polypharmacy, periventricular hyperintensity in frontal caps and occipital WMLs were strong predictors for falls, even after potential risk factors for falls were considered.
Regional white matter burden, independent of cognitive decline, correlates with balance/gait disturbance and predicts falls in elderly with aMCI and AD. Careful insight into regional WMLs on brain magnetic resonance may greatly help to diagnose demented elderly with a higher risk of falls.
预防痴呆老年人跌倒是一个临床挑战。从阿尔茨海默病（AD）早期开始，患者就表现出平衡和步态受损。本研究的目的是确定是否区域脑白质病变（WML）可以预测记忆力轻度认知障碍（aMCI）或 AD 老年患者的平衡/步态障碍和跌倒。
横断面研究。
医院门诊。
163 名被诊断为 aMCI 或 AD 的患者分为在过去一年中经历过跌倒（n=63）或未经历过跌倒（n=100）的组。
评估认知、抑郁、行为和心理症状、药物和平衡/步态功能。区域 WML 按照额帽的脑室周围高信号、带和枕帽，以及额、顶、颞和枕叶、基底节、丘脑和脑干的深部白质高信号进行视觉分析。脑萎缩以线性方式测量。
跌倒者的 WML 体积更大，其姿势/步态表现往往比非跌倒者差。特别是在特定脑区的几个 WML 与平衡和步态障碍密切相关。除了多种药物治疗外，额帽和枕部 WML 的脑室周围高信号也是跌倒的强烈预测因素，即使考虑了跌倒的潜在危险因素。
脑白质病变的区域负担，与认知下降无关，与记忆力轻度认知障碍和 AD 老年患者的平衡/步态障碍相关，并预测跌倒。仔细观察脑磁共振上的区域 WML 可能有助于诊断有较高跌倒风险的痴呆老年人。
