title: Risk of rapid global functional decline in elderly patients with severe cerebral age-related white matter changes: the LADIS study.
abstract: 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.
authors.affiliation: Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy. inzitari@neuro.unifi.it
authors.forename: Domenico
authors.initials: D
authors.lastname: Inzitari
authors.forename: Michela
authors.initials: M
authors.lastname: Simoni
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pracucci
authors.forename: Anna
authors.initials: A
authors.lastname: Poggesi
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Basile
authors.forename: Hugues
authors.initials: H
authors.lastname: Chabriat
authors.forename: Timo
authors.initials: T
authors.lastname: Erkinjuntti
authors.forename: Franz
authors.initials: F
authors.lastname: Fazekas
authors.forename: José M
authors.initials: JM
authors.lastname: Ferro
authors.forename: Michael
authors.initials: M
authors.lastname: Hennerici
authors.forename: Peter
authors.initials: P
authors.lastname: Langhorne
authors.forename: John
authors.initials: J
authors.lastname: O'Brien
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
authors.forename: Marieke C
authors.initials: MC
authors.lastname: Visser
authors.forename: Lars-Olof
authors.initials: LO
authors.lastname: Wahlund
authors.forename: Gunhild
authors.initials: G
authors.lastname: Waldemar
authors.forename: Anders
authors.initials: A
authors.lastname: Wallin
authors.forename: Leonardo
authors.initials: L
authors.lastname: Pantoni
mesh_terms: 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