title: White matter disease severity of the brain and its association with geriatric syndromes.
abstract: OBJECTIVE
  White matter disease (WMD) of the brain is considered to be secondary to small vessel ischemia and can be a single unifying risk factor for the development of geriatric syndromes. The aim of our study was to investigate the association of the global and regional severity of WMD in the brain with geriatric syndromes burden.
  
  
  METHODS
  In our retrospective study, consecutive outpatient charts from patients seen between January 2010 and June 2011 at University of Alberta Hospital Seniors Clinic were reviewed. Subjects with brain computed tomography (CT) scans were included in the study. Subjects with incomplete information or with diseases that confounded WMD assessment on CT were excluded. White matter disease was quantified on CT using Wahlund scoring. A multiple linear regression analysis was conducted to determine the association of WMD severity with geriatric syndromes burden after controlling for confounding vascular risk factors.
  
  
  RESULTS
  Of the 505 subjects, 326 (64.6%) were women. Mean age of the study patients was 79.8 years (SD ± 7.04), prevalence of WMD disease was 79.4%, and mean WMD score was 5.1 (SD ± 4.4). In subjects aged < and > 80 years, the mean number of geriatric syndromes was 2.83 (standard error of the mean [SE] 0.08) and 3.22 (SE 0.08), respectively. In the adjusted regression analysis, there was a significant association between WMD severity, globally (regression coefficient (β) = 0.457, SE 0.155; P = 0.003), as well as WMD in specific regions: frontal (P < 0.001), parieto-occipital (P = 0.004), and infratentorial regions (P = 0.04) with geriatric syndromes burden. The association remains even after correcting for age, sex, and all vascular risk factors.
  
  
  CONCLUSIONS
  In our study, there was a significant association between the severity of global and selected regional WMD of the brain with geriatric syndromes burden, thus raising the possibility of a shared biologic association through vascular pathology of the brain.
authors.affiliation: Associate Professor, Division of Geriatric Medicine, Department of Medicine. kalagiakri@aol.com.
authors.forename: Kannayiram
authors.initials: K
authors.lastname: Alagiakrishnan
authors.forename: Jenny
authors.initials: J
authors.lastname: Hsueh
authors.forename: Edwin
authors.initials: E
authors.lastname: Zhang
authors.forename: Khurshid
authors.initials: K
authors.lastname: Khan
authors.forename: Ambikaipakan
authors.initials: A
authors.lastname: Senthilselvan
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D056784:Leukoencephalopathies / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D012737:Sex Factors; D013577:Syndrome; D014057:Tomography, X-Ray Computed