Callisaya Michele L, Srikanth Velandai K, Lord Stephen R, Close Jacqueline C, Brodaty Henry, Sachdev Perminder S, Phan Thanh, Beare Richard, Trollor Julian, Wen Wei, Zheng Jacqueline J, Delbaere Kim
Department of Medicine, Southern Clinical School, Monash Medical Centre, Monash University, Melbourne, Australia; Menzies Research Institute, University of Tasmania, Hobart, Australia.
Int J Stroke. 2014 Oct;9 Suppl A100:55-60. doi: 10.1111/ijs.12279. Epub 2014 Apr 8.
White matter hyperintensities increase the risk of multiple falls in older people, but the effect of sub-cortical infarcts is unknown.
By pooling data from two Australian population-based studies, we aimed to investigate the association between sub-cortical infarcts and multiple falls and whether this relationship, and that of white matter hyperintensities, is mediated or modified by cognitive or sensorimotor factors.
Participants underwent structural magnetic resonance imaging and cognitive and sensorimotor assessments. Falls were prospectively measured over 12 months. Sub-cortical infarcts were detected visually. Total white matter hyperintensity volume was quantified using automated segmentation methods. Generalized linear models were used to examine if sub-cortical infarcts and white matter hyperintensities predicted falls.
The mean age of the sample (n = 655) was 74·5 (standard deviation 6·7) years, 336 (51·3%) males. Overall, 114 (17·4%) had multiple falls. The majority had no sub-cortical infarcts (n = 491, 75·0%), while 90 had one (13·7%), 41 had two (6·3%), and 33 had more than or equal to three sub-cortical infarcts (5·0%). The risk of multiple falls was elevated in people with more than or equal to three sub-cortical infarcts (adjusted relative risk 1·89, 95% confidence interval 1·03, 3·46) and in the highest quarter of white matter hyperintensity volume (adjusted relative risk 1·46, 95% confidence interval 1·00, 2·13). The effect of sub-cortical infarcts on falls was amplified by poorer vision (P = 0·03). The effect of white matter hyperintensities was amplified by poorer vision (P = 0·008), proprioception (P = 0·03), and muscle strength (P = 0·008). There was no modifying effect of cognitive function.
Increasing burdens of sub-cortical infarcts and white matter hyperintensities are associated with a risk of falling. Interventions targeting sensorimotor factors along with strategies to prevent sub-cortical infarcts and white matter hyperintensities may reduce the risk of falls.
脑白质高信号会增加老年人多次跌倒的风险，但皮质下梗死的影响尚不清楚。
通过汇总两项基于澳大利亚人群的研究数据，我们旨在研究皮质下梗死与多次跌倒之间的关联，以及这种关系以及脑白质高信号的关系是否由认知或感觉运动因素介导或调节。
参与者接受了结构磁共振成像以及认知和感觉运动评估。对跌倒情况进行了为期12个月的前瞻性测量。通过视觉检测皮质下梗死。使用自动分割方法对脑白质高信号总体积进行量化。使用广义线性模型来检验皮质下梗死和脑白质高信号是否可预测跌倒。
样本（n = 655）的平均年龄为74.5（标准差6.7）岁，男性336名（51.3%）。总体而言，114人（17.4%）有多次跌倒经历。大多数人没有皮质下梗死（n = 491，75.0%），而90人有1次（13.7%），41人有2次（6.3%），33人有3次及以上皮质下梗死（5.0%）。有3次及以上皮质下梗死的人多次跌倒的风险升高（调整后相对风险1.89，95%置信区间1.03至3.46），且在脑白质高信号体积最高的四分位数人群中也是如此（调整后相对风险1.46，95%置信区间1.00至2.13）。视力较差会放大皮质下梗死对跌倒的影响（P = 0.03）。视力较差（P = 0.008）、本体感觉（P = 0.03）和肌肉力量较差（P = 0.008）会放大脑白质高信号的影响。认知功能没有调节作用。
皮质下梗死和脑白质高信号负担的增加与跌倒风险相关。针对感觉运动因素的干预措施以及预防皮质下梗死和脑白质高信号的策略可能会降低跌倒风险。
