title: Clinical prediction of fall risk and white matter abnormalities: a diffusion tensor imaging study.
abstract: BACKGROUND
  The Tinetti scale is a simple clinical tool designed to predict risk of falling by focusing on gait and stance impairment in elderly persons. Gait impairment is also associated with white matter (WM) abnormalities.
  
  
  OBJECTIVE
  To test the hypothesis that elderly subjects at risk for falling, as determined by the Tinetti scale, have specific patterns of WM abnormalities on diffusion tensor imaging.
  
  
  METHODS
  Community-based cohort of 125 homebound elderly individuals.
  
  
  METHODS
  Diffusion tensor imaging scans were analyzed using tract-based spatial statistics analysis to determine the location of WM abnormalities in subjects with Tinetti scale scores of 25 or higher (without risk of falls) and lower than 25 (with risk of falls).Multivariate linear least squares correlation analysis was performed to determine the association between Tinetti scale scores and local fractional anisotropy values on each skeletal voxel controlling for possible confounders.
  
  
  RESULTS
  In subjects with risk of falls (Tinetti scale score <25), clusters of abnormal WM were seen in the medial frontal and parietal subcortical pathways, genu and splenium of corpus callosum, posterior cingulum, prefrontal and orbitofrontal pathways, and longitudinal pathways that connect frontal-parietal-temporal lobes. Among these abnormalities, those in medial frontal and parietal subcortical pathways correlated with Mini-Mental State Examination scores, while the other locations were unrelated to these scores.
  
  
  CONCLUSIONS
  Elderly individuals at risk for falls as determined by the Tinetti scale have WM abnormalities in specific locations on diffusion tensor imaging, some of which correlate with cognitive function scores.
authors.affiliation: Departments of Anatomy and Neurobiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Bang-Bon
authors.initials: BB
authors.lastname: Koo
authors.forename: Peter
authors.initials: P
authors.lastname: Bergethon
authors.forename: Wei Qiao
authors.initials: WQ
authors.lastname: Qiu
authors.forename: Tammy
authors.initials: T
authors.lastname: Scott
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hussain
authors.forename: Irwin
authors.initials: I
authors.lastname: Rosenberg
authors.forename: Louis R
authors.initials: LR
authors.lastname: Caplan
authors.forename: Rafeeque A
authors.initials: RA
authors.lastname: Bhadelia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016880:Anisotropy; D001921:Brain / Q000473:pathology*; D001931:Brain Mapping; D056324:Diffusion Tensor Imaging; D005260:Female; D020233:Gait Disorders, Neurologic / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D011237:Predictive Value of Tests; D012306:Risk; D012720:Severity of Illness Index