title: Progression of white matter hyperintensities of presumed vascular origin increases the risk of falls in older people.
abstract: BACKGROUND
  Greater volume of cerebral white matter hyperintensities (WMH) of presumed vascular origin may affect postural control and gait. WMH measured at one time point predicts an increased risk of incident multiple falls. However, it is unknown whether WMH progression increases falls risk. We hypothesized that the progression of WMH would be associated with a greater risk of multiple falls.
  
  
  METHODS
  A population-based sample aged more than 60 years was randomly selected from the electoral roll and followed up 2.5 years apart with two phases of measurement. Magnetic resonance imaging scans from both time points were subjected to automated segmentation to derive WMH volumes. Falls were recorded prospectively over 12 months after the second magnetic resonance imaging measurement. A generalized linear model was used to estimate the relative risk of multiple falls associated with WMH progression adjusted for confounders.
  
  
  RESULTS
  There were 187 people (mean age 70.4, SD 6.5) with a mean follow-up of 2.5 (SD 0.4) years. Over 12 months, 35 (18.7%) participants reported multiple falls. A greater progression of WMH was associated with an increased risk of multiple falls (adjusted relative risk 1.30, 95% confidence interval 1.00-1.70, p = .05) independent of baseline WMH volume, duration of follow-up, age, sex, and total intracranial volume. This association was unchanged when adjusted for medical history, peripheral sensorimotor factors, gait speed, cognition, medications, mood, and magnetic resonance imaging infarcts.
  
  
  CONCLUSIONS
  Greater WMH progression independently increased the risk of multiple falls. Interventions to slow the progression of WMH may be successful in reducing this risk.
authors.affiliation: Stroke and Ageing Research, Department of Medicine, Southern Clinical School, Monash University, Melbourne, Victoria, Australia. Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia. michele.callisaya@monash.edu.
authors.forename: Michele L
authors.initials: ML
authors.lastname: Callisaya
authors.affiliation: Stroke and Ageing Research, Department of Medicine, Southern Clinical School, Monash University, Melbourne, Victoria, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Beare
authors.affiliation: Stroke and Ageing Research, Department of Medicine, Southern Clinical School, Monash University, Melbourne, Victoria, Australia.
authors.forename: Thanh
authors.initials: T
authors.lastname: Phan
authors.affiliation: Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Leigh
authors.initials: L
authors.lastname: Blizzard
authors.affiliation: Stroke and Ageing Research, Department of Medicine, Southern Clinical School, Monash University, Melbourne, Victoria, Australia. Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.
authors.forename: Amanda G
authors.initials: AG
authors.lastname: Thrift
authors.affiliation: Southern Clinical School, Monash University, Melbourne, Victoria, Australia.
authors.forename: Jian
authors.initials: J
authors.lastname: Chen
authors.affiliation: Stroke and Ageing Research, Department of Medicine, Southern Clinical School, Monash University, Melbourne, Victoria, Australia. Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Velandai K
authors.initials: VK
authors.lastname: Srikanth
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D013648:Tasmania; D066127:White Matter / Q000098:blood supply / Q000473:pathology*
keywords: Brain aging; Epidemiology; Falls; Imaging; White matter hyperintensities.