Document Type

Article

Disciplines

Medicine and Health Sciences

Abstract

Objective

To compare MRI data to functional assessments of mobility, urinary control, and cognition to determine common or distinctive features in the distribution of brain white matter hyperintensities (WMHs) associated with functional decline/impairment.

Design

Baseline data from subjects 75-89 years enrolled in a longitudinal study. Assessors and subjects were blinded to group assignment.

Participants

99 subjects were enrolled using a balanced 3×3 matrix stratified by age and mobility performance. Exclusion criteria included: medication, systemic conditions, and neurologic diseases which can compromise mobility.

Setting

Healthy community-dwelling volunteers.

Measurements

WMHs were identified using semi-automated segmentation method and regional burdens were assessed utilizing a WM parcellation atlas. Quantitative measures of mobility, urinary incontinence (UI) severity and executive function/processing speed were obtained.

Results

WMHs occur predictably in predominantly periventricular areas. There were powerful correlations between global (tWMH) and regional WMH (rWMH) with r values of 0.5-0.9 for eight of ten structures analyzed. The tWMH predicted functional measures of UI, mobility and executive function/processing speed nearly as well as the best regional measures. The total volume of WMH independently explains 5-11% of the variability for mobility, UI severity and executive function/processing speed and is a sensitive (0.7-0.8) predictor of functional decline. The odds of decline in each of the three functional domains increased by 1.5 to 2.4 times with each 1% increase in tWMH.

Conclusion

This work establishes the importance of brain WMH burden in three major geriatric syndromes. Our findings support the inclusion of total WMH burden as a risk factor in the predictive/diagnostic criteria.

Comments

J Am Geriatr Soc. Author manuscript; available in PMC 2013 September 6. Published in final edited form as: J Am Geriatr Soc. 2010 February; 58(2): 275–281. Published online 2010 January 26. doi: 10.1111/j.1532-5415.2009.02699.x PMCID: PMC3764600 NIHMSID: NIHMS212514

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