title: Does leukoaraiosis predict morbidity and mortality?
abstract: OBJECTIVE
  To determine whether leukoaraiosis predicts morbidity and mortality.
  
  
  BACKGROUND
  Gait disturbance and leukoaraiosis both are common in the elderly. Gait disturbance predicts mortality. Leukoaraiosis may be a unifying factor to both gait disturbance and mortality.
  
  
  METHODS
  We followed 221 patients prospectively evaluated for severity of neurologic deficits by the National Institutes of Health (NIH) stroke scale and for leukoaraiosis in seven brain regions by CT, graded as absent (n = 119, 54%), mild (in at least one of seven brain regions; n = 54, 24%), or severe (present in all seven brain regions; n = 48, 22%). Pneumonia (n = 27, 12%), falls resulting in fracture requiring hospitalization (n = 7, 3%), and death (n = 38, 17%) were end points.
  
  
  RESULTS
  Severe leukoaraiosis predicted death (Cox hazard ratio [HR] = 2.91; 95% CI = 1.5 - 5.6), pneumonia (HR = 5.1; 95% CI = 2.4 - 10.9), death from pneumonia (HR = 8.3; 95% CI = 1.5 - 46), and falls (HR = 6.8; 95% CI = 1.5 - 30). Severe leukoaraiosis predicted a combined end point of death, pneumonia, and falls (HR = 3.5; 95% CI = 2 - 6). Other predictors were NIH stroke scale score, age, smoking, diabetes, gait score, and referral diagnosis of either dementia or Parkinsonism. Severe leukoaraiosis remained a predictor after adjustment for these other factors (HR = 2.2; 95% CI = 1.2 - 3.9), but was borderline after adjusting for gait (HR = 1.96; 95% CI = 0.97 - 3.94; p = 0.061). The combination of severe leukoaraiosis and gait disturbance had the highest risk (HR = 4.4; 95% CI = 2.4 - 7.9).
  
  
  CONCLUSIONS
  Severe leukoaraiosis predicts morbidity and mortality independently of preexisting neurologic deficits. The combination of leukoaraiosis and gait disturbance carries a poor prognosis.
authors.affiliation: Department of Medicine, Marshall University School of Medicine, and Huntington VAMC, WV, USA. dbriley@nildram.co.uk
authors.forename: D P
authors.initials: DP
authors.lastname: Briley
authors.forename: S
authors.initials: S
authors.lastname: Haroon
authors.forename: S M
authors.initials: SM
authors.lastname: Sergent
authors.forename: S
authors.initials: S
authors.lastname: Thomas
mesh_terms: D000058:Accidental Falls; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology*; D015331:Cohort Studies; D005684:Gait; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009017:Morbidity; D011014:Pneumonia / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed