title: White matter lesions are associated with hospital admissions because of hip-fractures and trauma after ischemic stroke.
abstract: OBJECTIVE
  Cerebral white matter lesions (WMLs), a surrogate for cerebral small-vessel disease, have been shown to be associated with decreasing mobility, gait instability, and falls. The aim of this study was to investigate whether WMLs of the brain are associated with increased incidence of hospital admissions because of any trauma and hip-fractures in a cohort of patients with stroke.
  
  
  METHODS
  We included 383 consecutive patients aged 55 to 85 years with ischemic stroke admitted to the Helsinki University Central Hospital (The Stroke Aging Memory cohort) with a 12-year follow-up. National register data were reviewed for hip-fractures, other traumatic injuries, survival data, and causes of death. WMLs were rated using MRI and dichotomized as none to mild and moderate to severe. The data were analyzed using Kaplan-Meier plots (log-rank) and a complex Cox multivariable hazards models for multiple cases per subject to assess hazard ratios with their 95% confidence intervals.
  
  
  RESULTS
  During the 12-year follow-up, there were more hip-fractures (13.5% versus 6.5%; log-rank, P=0.01) and more hospital admissions because of traumatic injury (22.2% versus 16.7%; log-rank, P=0.04) in the moderate-to-severe than in the none-to-mild WMLs group. In the complex samples, Cox multivariable model adjusting for age, sex, National Institutes of Health Stroke Scale, infarct size, and poststroke dementia, moderate-to-severe WMLs were associated with increased incidences of hospital admissions because of hip-fractures (hazard ratio, 3.98; 95% confidence interval, 1.55-10.21) and traumatic injuries including hip-fractures (hazard ratio, 1.72; 95% confidence interval, 1.03-2.87).
  
  
  CONCLUSIONS
  Patients with ischemic stroke and moderate-to-severe WMLs are at high risk, who experience serious traumatic injuries and especially hip-fractures requiring hospital treatment.
authors.affiliation: From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (G.S., S.C., S.M., T.P., M.K., T.E.) and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (G.S., S.C., S.M., T.P., M.K., T.E.); School of Medicine, University of Tampere and FimLab Laboratories Ltd, Tampere University Hospital Region, Tampere, Finland (P.J.K., N.K.J.O.); Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Finland (N.K.J.O.); Department of Medicine, Geriatric Clinic, University of Helsinki and University Central Hospital, Helsinki, Finland (T.S.); and Institute of Health Sciences/Geriatrics, University Hospital and Health Center of Oulu, Oulu, Finland (T.S.). gerli.sibolt@hus.fi.
authors.forename: Gerli
authors.initials: G
authors.lastname: Sibolt
authors.affiliation: From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (G.S., S.C., S.M., T.P., M.K., T.E.) and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (G.S., S.C., S.M., T.P., M.K., T.E.); School of Medicine, University of Tampere and FimLab Laboratories Ltd, Tampere University Hospital Region, Tampere, Finland (P.J.K., N.K.J.O.); Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Finland (N.K.J.O.); Department of Medicine, Geriatric Clinic, University of Helsinki and University Central Hospital, Helsinki, Finland (T.S.); and Institute of Health Sciences/Geriatrics, University Hospital and Health Center of Oulu, Oulu, Finland (T.S.).
authors.forename: Sami
authors.initials: S
authors.lastname: Curtze
authors.affiliation: From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (G.S., S.C., S.M., T.P., M.K., T.E.) and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (G.S., S.C., S.M., T.P., M.K., T.E.); School of Medicine, University of Tampere and FimLab Laboratories Ltd, Tampere University Hospital Region, Tampere, Finland (P.J.K., N.K.J.O.); Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Finland (N.K.J.O.); Department of Medicine, Geriatric Clinic, University of Helsinki and University Central Hospital, Helsinki, Finland (T.S.); and Institute of Health Sciences/Geriatrics, University Hospital and Health Center of Oulu, Oulu, Finland (T.S.).
authors.forename: Susanna
authors.initials: S
authors.lastname: Melkas
authors.affiliation: From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (G.S., S.C., S.M., T.P., M.K., T.E.) and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (G.S., S.C., S.M., T.P., M.K., T.E.); School of Medicine, University of Tampere and FimLab Laboratories Ltd, Tampere University Hospital Region, Tampere, Finland (P.J.K., N.K.J.O.); Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Finland (N.K.J.O.); Department of Medicine, Geriatric Clinic, University of Helsinki and University Central Hospital, Helsinki, Finland (T.S.); and Institute of Health Sciences/Geriatrics, University Hospital and Health Center of Oulu, Oulu, Finland (T.S.).
authors.forename: Tarja
authors.initials: T
authors.lastname: Pohjasvaara
authors.affiliation: From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (G.S., S.C., S.M., T.P., M.K., T.E.) and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (G.S., S.C., S.M., T.P., M.K., T.E.); School of Medicine, University of Tampere and FimLab Laboratories Ltd, Tampere University Hospital Region, Tampere, Finland (P.J.K., N.K.J.O.); Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Finland (N.K.J.O.); Department of Medicine, Geriatric Clinic, University of Helsinki and University Central Hospital, Helsinki, Finland (T.S.); and Institute of Health Sciences/Geriatrics, University Hospital and Health Center of Oulu, Oulu, Finland (T.S.).
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
authors.affiliation: From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (G.S., S.C., S.M., T.P., M.K., T.E.) and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (G.S., S.C., S.M., T.P., M.K., T.E.); School of Medicine, University of Tampere and FimLab Laboratories Ltd, Tampere University Hospital Region, Tampere, Finland (P.J.K., N.K.J.O.); Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Finland (N.K.J.O.); Department of Medicine, Geriatric Clinic, University of Helsinki and University Central Hospital, Helsinki, Finland (T.S.); and Institute of Health Sciences/Geriatrics, University Hospital and Health Center of Oulu, Oulu, Finland (T.S.).
authors.forename: Pekka J
authors.initials: PJ
authors.lastname: Karhunen
authors.affiliation: From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (G.S., S.C., S.M., T.P., M.K., T.E.) and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (G.S., S.C., S.M., T.P., M.K., T.E.); School of Medicine, University of Tampere and FimLab Laboratories Ltd, Tampere University Hospital Region, Tampere, Finland (P.J.K., N.K.J.O.); Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Finland (N.K.J.O.); Department of Medicine, Geriatric Clinic, University of Helsinki and University Central Hospital, Helsinki, Finland (T.S.); and Institute of Health Sciences/Geriatrics, University Hospital and Health Center of Oulu, Oulu, Finland (T.S.).
authors.forename: Niku K J
authors.initials: NK
authors.lastname: Oksala
authors.affiliation: From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (G.S., S.C., S.M., T.P., M.K., T.E.) and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (G.S., S.C., S.M., T.P., M.K., T.E.); School of Medicine, University of Tampere and FimLab Laboratories Ltd, Tampere University Hospital Region, Tampere, Finland (P.J.K., N.K.J.O.); Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Finland (N.K.J.O.); Department of Medicine, Geriatric Clinic, University of Helsinki and University Central Hospital, Helsinki, Finland (T.S.); and Institute of Health Sciences/Geriatrics, University Hospital and Health Center of Oulu, Oulu, Finland (T.S.).
authors.forename: Timo
authors.initials: T
authors.lastname: Strandberg
authors.affiliation: From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (G.S., S.C., S.M., T.P., M.K., T.E.) and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (G.S., S.C., S.M., T.P., M.K., T.E.); School of Medicine, University of Tampere and FimLab Laboratories Ltd, Tampere University Hospital Region, Tampere, Finland (P.J.K., N.K.J.O.); Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Finland (N.K.J.O.); Department of Medicine, Geriatric Clinic, University of Helsinki and University Central Hospital, Helsinki, Finland (T.S.); and Institute of Health Sciences/Geriatrics, University Hospital and Health Center of Oulu, Oulu, Finland (T.S.).
authors.forename: Timo
authors.initials: T
authors.lastname: Erkinjuntti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply; D001927:Brain Diseases / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006620:Hip Fractures / Q000150:complications*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D016016:Proportional Hazards Models; D020521:Stroke / Q000150:complications*; D066127:White Matter / Q000473:pathology*; D014947:Wounds and Injuries
keywords: cerebral small vessel diseases; hip fractures; trauma