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Association of gait and balance disorders with age-related white matter changes

The LADIS Study

From the Department of Neurology (H.B., C.B., M.G.H.), University of Heidelberg, Klinikum Mannheim, Mannheim, Germany; Department of Neurological and Psychiatric Sciences (A.P., L.P., D.I.), University of Florence, Italy; Department of Neurology (H.C.), Hopital Lariboisiere, Paris, France; Memory Research Unit (T.E.), Department of Clinical Neurosciences, Helsinki University, Helsinki, Finland; Department of Neurology and MRI Institute (F.F.), Medical University Graz, Austria; Serviço de Neurologia (J.M.F.), Centro de Estudos Egas Moniz, Hospital de Santa Maria Lisboa, Portugal; Academic Department for Geriatric Medicine (P.L.), Glasgow Royal Infirmary, Glasgow, Scotland; Institute for Ageing and Health (J.O.), University of Newcastle, Newcastle Upon Tyne, United Kingdom; Departments of Radiology and Neurology (P.S., M.C.V.), VU Medical Center, Amsterdam, The Netherlands; Karolinska Institute (L.O.W.), Department of Clinical Neuroscience and Family Medicine, Huddinge, University Hospital, Huddinge, Sweden; Memory Disorders Research Group (G.W.), Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark; and Institute of Clinical Neuroscience (A.W.), Goteborg University, Goteborg, Sweden.

Address correspondence and reprint requests to Dr. Hansjoerg Baezner, Mannheim University Hospital, University of Heidelberg, Department of Neurology, Theodor Kutzer Ufer, D-68135 Mannheim, Germany baezner{at}neuro.ma.uni-heidelberg.de

Objective: In the Leukoaraiosis and Disability (LADIS) Study, 11 European centers are evaluating the role of age-related white matter changes (ARWMC) as an independent determinant of the transition to disability in the elderly (65 to 84 years). We aimed at determining the influence of ARWMC on different objective measures of gait and balance.

Methods: Six hundred thirty-nine nondisabled individuals were prospectively enrolled and are being followed-up for 3 years. Subjects are graded in three standardized categories of ARWMC (mild, moderate, and severe) according to central MRI reading. Quantitative tests of gait and balance include the Short Physical Performance Battery (SPPB; range: 0 [poor] to 12 [normal]), a timed 8-m walk, and a timed single leg stance test.

Results: In cross-sectional analysis, deficiencies in gait and balance performance were correlated with the severity of ARWMC (SPPB: 10.2 ± 2.1 in the mild, 9.9 ± 2.0 in the moderate, 8.9 ± 2.6 in the severe group; p < 0.001). Walking speed correlated with the severity of ARWMC (1.24 ± 0.28 m/second in the mild, 1.18 ± 0.32 m/second in the moderate, and 1.09 ± 0.31 m/second in the severe group; p < 0.001). Balance was best in individuals with mild ARWMC (single leg stance time: 18.9 ± 10.8 seconds) compared with moderate and severe ARWMC (16.4 ± 10.8 and 13.6 ± 11.2 seconds) (p < 0.001). Physically inactive individuals had a higher risk of a pathologic SPPB score (moderate vs mild ARWMC: odds ratio 1.60, 95% CI 1.02 to 2.52; severe vs mild ARWMC: odds ratio 1.75, 95% CI 1.09 to 2.80).

Conclusions: Our findings support a strong association between the severity of age-related white matter changes and the severity of gait and motor compromise. Physical activity might have the potential to reduce the risk of limitations in mobility.

Abbreviations: ANOVA = analysis of variance; ARWMC = age-related white matter changes; LADIS = Leukoaraiosis and Disability; MR = magnetic resonance; OR = odds ratio; SPPB = Short Physical Performance Battery.

*Participating centers and LADIS study personnel are listed in the appendix.

The LADIS Study is supported by the European Union within the Fifth European framework Program "Quality of Life and Management of Living Resources" (1998 to 2002), contract no. QLRT-2000-00446, as a concerted action.

Disclosure: The authors report no conflicts of interest.

Received April 11, 2007. Accepted in final form October 30, 2007.

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