title: Association of gait and balance disorders with age-related white matter changes: the LADIS study.
abstract: OBJECTIVE
  In the Leukoaraiosis and Disability (LADIS) Study, 11 European centers are evaluating the role of age-related white matter changes (ARWMC) as an independent determinant of the transition to disability in the elderly (65 to 84 years). We aimed at determining the influence of ARWMC on different objective measures of gait and balance.
  
  
  METHODS
  Six hundred thirty-nine nondisabled individuals were prospectively enrolled and are being followed-up for 3 years. Subjects are graded in three standardized categories of ARWMC (mild, moderate, and severe) according to central MRI reading. Quantitative tests of gait and balance include the Short Physical Performance Battery (SPPB; range: 0 [poor] to 12 [normal]), a timed 8-m walk, and a timed single leg stance test.
  
  
  RESULTS
  In cross-sectional analysis, deficiencies in gait and balance performance were correlated with the severity of ARWMC (SPPB: 10.2 +/- 2.1 in the mild, 9.9 +/- 2.0 in the moderate, 8.9 +/- 2.6 in the severe group; p < 0.001). Walking speed correlated with the severity of ARWMC (1.24 +/- 0.28 m/second in the mild, 1.18 +/- 0.32 m/second in the moderate, and 1.09 +/- 0.31 m/second in the severe group; p < 0.001). Balance was best in individuals with mild ARWMC (single leg stance time: 18.9 +/- 10.8 seconds) compared with moderate and severe ARWMC (16.4 +/- 10.8 and 13.6 +/- 11.2 seconds) (p < 0.001). Physically inactive individuals had a higher risk of a pathologic SPPB score (moderate vs mild ARWMC: odds ratio 1.60, 95% CI 1.02 to 2.52; severe vs mild ARWMC: odds ratio 1.75, 95% CI 1.09 to 2.80).
  
  
  CONCLUSIONS
  Our findings support a strong association between the severity of age-related white matter changes and the severity of gait and motor compromise. Physical activity might have the potential to reduce the risk of limitations in mobility.
authors.affiliation: Mannheim University Hospital, University of Heidelberg, Department of Neurology, Theodor Kutzer Ufer, D-68135 Mannheim, Germany. baezner@neuro.ma.uni-heidelberg.de
authors.forename: H
authors.initials: H
authors.lastname: Baezner
authors.forename: C
authors.initials: C
authors.lastname: Blahak
authors.forename: A
authors.initials: A
authors.lastname: Poggesi
authors.forename: L
authors.initials: L
authors.lastname: Pantoni
authors.forename: D
authors.initials: D
authors.lastname: Inzitari
authors.forename: H
authors.initials: H
authors.lastname: Chabriat
authors.forename: T
authors.initials: T
authors.lastname: Erkinjuntti
authors.forename: F
authors.initials: F
authors.lastname: Fazekas
authors.forename: J M
authors.initials: JM
authors.lastname: Ferro
authors.forename: P
authors.initials: P
authors.lastname: Langhorne
authors.forename: J
authors.initials: J
authors.lastname: O'Brien
authors.forename: P
authors.initials: P
authors.lastname: Scheltens
authors.forename: M C
authors.initials: MC
authors.lastname: Visser
authors.forename: L O
authors.initials: LO
authors.lastname: Wahlund
authors.forename: G
authors.initials: G
authors.lastname: Waldemar
authors.forename: A
authors.initials: A
authors.lastname: Wallin
authors.forename: M G
authors.initials: MG
authors.lastname: Hennerici
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005081:Exercise Therapy / Q000592:standards; D005260:Female; D020233:Gait Disorders, Neurologic / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D049292:Leukoaraiosis / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D010809:Physical Fitness / Q000502:physiology; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D015837:Vestibular Diseases / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology