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From the Departments of Neurology (Drs. Tang and Baloh and A. Lin) and Surgery (Head and Neck) (Dr. Baloh), University of California at Los Angeles School of Medicine; and the Department of Neurology (Dr. Whitman), University of California at Irvine College of Medicine.
Address correspondence and reprint requests to Dr. Robert W. Baloh, UCLA Reed Neurological Research Center, Box 951769, 710 Westwood Plaza, Los Angeles, CA 90095-1769; e-mail: rwbaloh{at}ucla.edu
Objectives:— The authors previously reported cross-sectional data suggesting a relationship between cerebral white matter hyperintensities (WMH) and gait and balance dysfunction in older people. There have been no longitudinal MRI studies to address this issue. The current study compared progression of WMH in subjects with gait and balance dysfunction with that in healthy subjects.
Methods:— Two brain MRI were performed on 70 healthy, ambulatory subjects (mean baseline age 79, range 74 to 88) with no identifiable neurologic disease. The mean time between MRI was 4 years. Gait and balance were quantified using the Tinetti Balance and Mobility Scale, and falls were documented each year. On T2-weighted MRI, total hyperintense volume (HV) within three periventricular levels was estimated using the Cavalieri principle, and WMH were graded (0 to 4) using an established semiquantitative scale.
Results:— Compared with those with normal gait and balance, subjects whose Tinetti scores dropped markedly (>4 points) between first and second MRI showed a significantly greater mean increase in HV during follow-up. The larger group of subjects with an abnormal Tinetti score (<24) at the time of second MRI showed a significantly greater mean increase in HV, compared with those with normal gait and balance at follow-up. Subjects with marked WMH at baseline showed significantly greater increase in HV over time. Subjects with abnormal Tinetti scores had significantly more falls than subjects with normal Tinetti scores.
Conclusions:— Some older people develop gait and balance dysfunction that is associated with gradual onset of cerebral white matter disease.
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