Clancy Úna, Puttock Eric J, Chen Wansu, Whiteley William, Vickery Ellen M, Leung Lester Y, Luetmer Patrick H, Kallmes David F, Fu Sunyang, Zheng Chengyi, Liu Hongfang, Kent David M
Centre for Clinical Brain Sciences, Edinburgh Imaging, and UK Dementia Research Institute, University of Edinburgh, United Kingdom (U.C., W.W.).
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (E.J.P., W.C., C.Z.).
Stroke. 2025 Jun 27. doi: 10.1161/STROKEAHA.124.050137.
The impact of covert cerebrovascular disease on falls in the general population is not well-known. Here, we determine the time to a first fall following incidentally detected covert cerebrovascular disease during a clinical neuroimaging episode.
This longitudinal cohort study assessed computed tomography (CT) and magnetic resonance imaging from 2009 to 2019 of patients aged >50 years registered with Kaiser Permanente Southern California which is a healthcare organization combining health plan coverage with coordinated medical services, excluding those with before stroke/dementia. We extracted evidence of incidental covert brain infarcts (CBI) and white matter hyperintensities/hypoattenuation (WMH) from imaging reports using natural language processing. We examined associations of CBI and WMH with falls requiring medical attention, using Cox proportional hazards regression models with adjustment for 12 variables including age, sex, ethnicity multimorbidity, polypharmacy, and incontinence.
We assessed 241 050 patients, mean age 64.9 (SD, 10.42) years, 61.3% female, detecting covert cerebrovascular disease in 31.1% over a mean follow-up duration of 3.04 years. A recorded fall occurred in 21.2% (51 239/241 050) during follow-up. On CT, single fall incidence rate/1000 person-years (p-y) was highest in individuals with both CBI and WMH on CT (129.3 falls/1000 p-y [95% CI, 123.4-135.5]), followed by WMH (109.9 falls/1000 p-y [108.0-111.9]). On magnetic resonance imaging, the incidence rate was the highest with both CBI and WMH (76.3 falls/1000 p-y [95% CI, 69.7-83.2]), followed by CBI (71.4 falls/1000 p-y [95% CI, 65.9-77.2]). The adjusted hazard ratio for single index fall in individuals with CBI on CT was 1.13 (95% CI, 1.09-1.17); versus magnetic resonance imaging 1.17 (95% CI, 1.08-1.27). On CT, the risk for single index fall incrementally increased for mild (1.37 [95% CI, 1.32-1.43]), moderate (1.57 [95% CI, 1.48-1.67]), or severe WMH (1.57 [95% CI, 1.45-1.70]). On magnetic resonance imaging, index fall risk similarly increased with increasing WMH severity: mild (1.11 [95% CI, 1.07-1.17]), moderate (1.21 [95% CI, 1.13-1.28]), and severe WMH (1.34 [95% CI, 1.22-1.46]).
In a large population with neuroimaging, CBI and WMH are independently associated with greater risks of an index fall. Increasing severities of WMH are associated incrementally with fall risk across imaging modalities.
隐匿性脑血管疾病对普通人群跌倒的影响尚不明确。在此，我们确定在临床神经影像学检查期间偶然发现隐匿性脑血管疾病后首次跌倒的时间。
这项纵向队列研究评估了2009年至2019年加利福尼亚州南部凯撒医疗集团（Kaiser Permanente Southern California）登记的年龄大于50岁患者的计算机断层扫描（CT）和磁共振成像，该医疗组织将健康保险覆盖与协调医疗服务相结合，排除有中风/痴呆病史的患者。我们使用自然语言处理从影像报告中提取偶然隐匿性脑梗死（CBI）和白质高信号/低密度（WMH）的证据。我们使用Cox比例风险回归模型，并对包括年龄、性别、种族、多种疾病、多种药物治疗和失禁在内的12个变量进行调整，研究CBI和WMH与需要医疗关注的跌倒之间的关联。
我们评估了241050名患者，平均年龄64.9（标准差，10.42）岁，女性占61.3%，在平均3.04年的随访期内，31.1%的患者检测到隐匿性脑血管疾病。随访期间，21.2%（51239/241050）的患者有跌倒记录。在CT上，CT检查同时发现CBI和WMH的个体中，单次跌倒发病率/1000人年（p-y）最高（129.3次跌倒/1000 p-y [95%可信区间，123.4 - 135.5]），其次是WMH（109.9次跌倒/1000 p-y [108.0 - 111.9]）。在磁共振成像上，CBI和WMH同时存在时发病率最高（76.3次跌倒/1000 p-y [95%可信区间，69.7 - 83.2]），其次是CBI（71.4次跌倒/1000 p-y [95%可信区间，65.9 - 77.2]）。CT检查发现CBI的个体中，单次跌倒的调整后风险比为1.13（95%可信区间，1.09 - 1.17）；磁共振成像检查时为1.17（95%可信区间，1.08 - 1.27）。在CT上，轻度（1.37 [95%可信区间，1.32 - 1.43]）、中度（1.57 [95%可信区间，1.48 - 1.67]）或重度WMH（1.57 [95%可信区间，1.45 - 1.70]）时，单次跌倒风险逐渐增加。在磁共振成像上，随着WMH严重程度增加，跌倒风险同样增加：轻度（1.11 [95%可信区间，1.07 - 1.17]）、中度（1.21 [95%可信区间，1.13 - 1.28]）和重度WMH（1.34 [95%可信区间，1.22 - 1.46]）。
在进行神经影像学检查的大量人群中，CBI和WMH与首次跌倒风险增加独立相关。跨影像模式，WMH严重程度增加与跌倒风险逐渐增加相关。
