Risk of rapid global functional decline in elderly patients with severe cerebral age-related white matter changes: the LADIS study.
BACKGROUND
Age-related white matter changes (ARWMCs), frequently detected on neuroimaging, are associated with motor, cognitive, urinary, and mood disorders. The LADIS (LeukoAraiosis and DISability) Study primarily aims to assess ARWMCs as a determinant of global functional decline in the elderly population.


METHODS
We enrolled 639 patients (mean age, 74.1 +/- 5.0 years; 45.1% male) referred for nondisabling complaints, who had ARWMCs detected on brain magnetic resonance imaging (MRI) of mild, moderate, or severe grade according to the Fazekas scale. At the 1-year follow-up, 619 were reassessed using the Instrumental Activities of Daily Living (IADL) scale. Of these, 506 were totally independent at baseline, and 113 were impaired in only 1 item of the IADL scale. We studied the 1-year transition to 2 or more activities limited and selective functional impairments as cofactors of functional decline.


RESULTS
The rate of transition was 9%, 15%, and 26%, in the mild, moderate, and severe ARWMC group, respectively. Comparing the severe with the mild ARWMC groups and adjusting for age and for other predictors of decline, the risk was more than 2-fold higher (odds ratio; 2.38; 95% confidence interval, 1.29-4.38) in patients with 0 or 1 activity limited, and 3-fold higher (odds ratio, 3.02; 95% confidence interval, 1.34-6.78) among patients fully independent at baseline. Both motor and cognitive deterioration predominantly explained the effect of ARWMCs on global functional decline.


CONCLUSIONS
Elderly patients who are functionally independent and who have severe ARWMCs are at considerable risk of becoming more dependent in a short period, mostly owing to motor and cognitive deterioration.
Inzitari
Domenico
D
Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy. inzitari@neuro.unifi.it
Simoni
Michela
M
Pracucci
Giovanni
G
Poggesi
Anna
A
Basile
Anna Maria
AM
Chabriat
Hugues
H
Erkinjuntti
Timo
T
Fazekas
Franz
F
Ferro
José M
JM
Hennerici
Michael
M
Langhorne
Peter
P
O'Brien
John
J
Barkhof
Frederik
F
Visser
Marieke C
MC
Wahlund
Lars-Olof
LO
Waldemar
Gunhild
G
Wallin
Anders
A
Pantoni
Leonardo
L
D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049292:Leukoaraiosis / Q000503:physiopathology* / Q000523:psychology; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D016017:Odds Ratio; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index