The relationship between white matter hyperintensity clusters (size and location) and prospective falls in older adults across the cognitive spectrum
Taylor ME[1, 2, 3], Delbaere K[1, 4], Lord SR[1, 4], Sachdev PS[5, 6, 7], Wen W[5, 6], Jiang J[5, 6], Brodaty H[6, 7], Kurrle SE[2], Sturnieks D[1,8], Trollor J[6, 9] and Close JCT[1, 3]
- Falls, Balance and Injury Research Centre, NeuRA, UNSW Sydney, Sydney, Australia.
- Cognitive Decline Partnership Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Prince of Wales Clinical School, Medicine, UNSW Sydney, Sydney, Australia.
- School of Public Health and Community Medicine, Medicine, UNSW Sydney, Sydney, Australia.
- Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, Australia.
- Centre for Healthy Brain Ageing, School of Psychiatry, Medicine, UNSW Sydney, Sydney, Australia.
- Dementia Centre for Research Collaboration, School of Psychiatry, Medicine, UNSW Sydney, Sydney, Australia.
- School of Medical Sciences, Medicine, UNSW Sydney, Sydney, Australia.
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, Australia.
Objectives: The relationship between white matter hyperintensity (WMH) clusters and, physical performance and falls remains unexamined. Investigating WMH clusters (size/location) may identify differential effects in relation to WMH aetiology and, physical performance and fall risk. We hypothesized an association between the number of WMH clusters (NoCs) and sensorimotor function and falls, and that this relationship would be strongest in the frontal brain region.
Measurements: At baseline, 168 community-dwelling older people underwent Magnetic Resonance Imaging and sensorimotor and neuropsychological assessment. WMH NoCs were quantified using fully-automated methods. Falls were ascertained prospectively for 12-months.
Results: The sample included participants who were cognitively intact (n=79), had MCI (n=61) and dementia (n=28), their mean age was 79±5 years and 53% were female. In minimally-adjusted analyses (age, sex, education, Mini-Mental State Examination, vascular risk, scanner), total, focal, medium and confluent whole-brain NoCs and frontal, temporal and parietal NoCs were associated with faller status. In fully-adjusted analyses, further adjusting for total WMH volume, mood, executive and sensorimotor function, total, focal, temporal and parietal NoCs remained significantly associated with falls. Sensorimotor function showed significant relationships with focal, frontal and parietal NoCs.
Conclusions: Total, focal, parietal and temporal NoCs were independently associated with falls. The strength of the association between frontal NoCs and falls was affected by mood, sensorimotor and executive function, which may be secondary to the known relationships between fronto-executive circuits and sensorimotor function and/or apathy. WMH clusters present as a novel fall risk factor in this study. However, these findings need validating in future studies.