title: Cerebral white matter changes are associated with abnormalities on neurological examination in non-disabled elderly: the LADIS study.
abstract: Cerebral white matter changes (WMC) are associated with motor, cognitive, mood, urinary disturbances, and disability, but little is known about the prevalence of neurological signs in patients with these brain lesions. We assessed the presence and occurrence of neurological abnormalities over a 3-year period and their possible associations with WMC in a cohort of initially non-disabled elderly subjects. Data from the multicenter Leukoaraiosis And DISability study were used. A standard neurological examination was performed at baseline and at each of the annual follow-up visits. A standard MRI scan was performed at baseline and after 3-years. WMC severity was graded as mild, moderate, or severe on the Fazekas scale, while the Rotterdam scale was used to assess progression. Infarcts and their occurrence were also assessed. Six hundred and thirty-nine non-disabled subjects were enrolled (mean age 74.1 ± 5.0, M/F: 288/351). Severe WMC at baseline were associated with gait and stance abnormalities, upper motor signs, and fingertap slowing. This effect was independent of age, sex, lacunar and non-lacunar infarcts. The occurrence of stance abnormalities, upper motor signs, primitive reflexes and fingertap slowing during the 3-year follow-up period was associated with both baseline WMC load and their progression. The occurrence of the same abnormalities plus extrapyramidal and primitive reflexes was associated with incident lacunar infarcts. In our cohort of non-disabled elders, severe WMC were associated with the presence and the occurrence of neurological signs, independently of other vascular brain lesions, confirming that these lesions have clinical relevance.
authors.affiliation: Department of Neurological and Psychiatric Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Poggesi
authors.forename: Alida
authors.initials: A
authors.lastname: Gouw
authors.forename: Wiesje
authors.initials: W
authors.lastname: van der Flier
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pracucci
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 T
authors.initials: JT
authors.lastname: O'Brien
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: Philip
authors.initials: P
authors.lastname: Scheltens
authors.forename: Domenico
authors.initials: D
authors.lastname: Inzitari
authors.forename: Leonardo
authors.initials: L
authors.lastname: Pantoni
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology / Q000523:psychology; D000704:Analysis of Variance; D002540:Cerebral Cortex / Q000473:pathology*; D004185:Disability Evaluation; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D009422:Nervous System Diseases / Q000473:pathology*; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D016017:Odds Ratio