title: Regional white matter lesions predict falls in patients with amnestic mild cognitive impairment and Alzheimer's disease.
abstract: OBJECTIVE
  Preventive strategy for falls in demented elderly is a clinical challenge. From early-stage of Alzheimer's disease (AD), patients show impaired balance and gait. The purpose of this study is to determine whether regional white matter lesions (WMLs) can predict balance/gait disturbance and falls in elderly with amnestic mild cognitive impairment (aMCI) or AD.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Hospital out-patient clinic.
  
  
  METHODS
  One hundred sixty-three patients diagnosed with aMCI or AD were classified into groups having experienced falls (n = 63) or not (n = 100) in the previous year.
  
  
  METHODS
  Cognition, depression, behavior and psychological symptoms of dementia, medication, and balance/gait function were evaluated. Regional WMLs were visually analyzed as periventricular hyperintensity in frontal caps, bands, and occipital caps, and as deep white matter hyperintensity in frontal, parietal, temporal, and occipital lobes, basal ganglia, thalamus, and brain stem. Brain atrophy was linearly measured.
  
  
  RESULTS
  The fallers had a greater volume of WMLs and their posture/gait performance tended to be worse than nonfallers. Several WMLs in particular brain regions were closely associated with balance and gait impairment. Besides polypharmacy, periventricular hyperintensity in frontal caps and occipital WMLs were strong predictors for falls, even after potential risk factors for falls were considered.
  
  
  CONCLUSIONS
  Regional white matter burden, independent of cognitive decline, correlates with balance/gait disturbance and predicts falls in elderly with aMCI and AD. Careful insight into regional WMLs on brain magnetic resonance may greatly help to diagnose demented elderly with a higher risk of falls.
authors.affiliation: Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Ogama
authors.affiliation: Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan. Electronic address: tsakurai@ncgg.go.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakurai
authors.affiliation: Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.
authors.forename: Atsuya
authors.initials: A
authors.lastname: Shimizu
authors.affiliation: Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Toba
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000544:Alzheimer Disease / Q000150:complications*; D000647:Amnesia / Q000150:complications*; D001284:Atrophy; D001921:Brain / Q000473:pathology*; D060825:Cognitive Dysfunction / Q000150:complications*; D003430:Cross-Sectional Studies; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D019338:Polypharmacy; D012307:Risk Factors; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
keywords: Alzheimer's disease; White matter lesions; amnestic mild cognitive impairment; falls