title: Association of postural instability with asymptomatic cerebrovascular damage and cognitive decline: the Japan Shimanami health promoting program study.
abstract: OBJECTIVE
  Asymptomatic cerebral small-vessel disease (cSVD) in elderly individuals are potent risk factors for stroke. In addition to common clinical risk factors, postural instability has been postulated to be associated with cSVD in older frail patients. Here, we conducted a cross-sectional study to understand the possible link between postural instability and asymptomatic cSVD further, namely periventricular hyperintensity, lacunar infarction, and microbleeds, as well as cognitive function, in a middle-aged to elderly general population (n=1387).
  
  
  METHODS
  Postural instability was assessed based on one-leg standing time (OLST) and posturography findings. cSVD was evaluated by brain MRI. Mild cognitive impairment was assessed using a computer-based questionnaire, and carotid intima-media thickness as an index of atherosclerosis was measured via ultrasonography.
  
  
  RESULTS
  Frequency of short OLST, in particular <20 s, increased linearly with severity of cSVD (lacunar infarction lesion: none, 9.7%; 1, 16.0%; >2, 34.5%; microbleeds lesion: none, 10.1%; 1, 15.3%; >2, 30.0%; periventricular hyperintensity grade: 0, 5.7%; 1, 11.5%; >2, 23.7%). The association of short OLST with lacunar infarction and microbleeds but not periventricular hyperintensity remained significant even after adjustment for possible covariates (lacunar infarction, P=0.009; microbleeds, P=0.003; periventricular hyperintensity, P=0.601). In contrast, no significant association was found between posturographic parameters and cSVD, whereas these parameters were linearly associated with OLST. Short OLST was also significantly associated with reduced cognitive function independent of covariates, including cSVD (P=0.002).
  
  
  CONCLUSIONS
  Postural instability was found to be associated with early pathological changes in the brain and functional decline, even in apparently healthy subjects.
authors.affiliation: From the Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan (Y.T., T.M., F.M.); and Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan (Y.T., Y.O., M.O., E.U., T.K., N.O., T.N., M.I., T.M., K.K.). tabara@genome.med.kyoto-u.ac.jp.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Tabara
authors.affiliation: From the Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan (Y.T., T.M., F.M.); and Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan (Y.T., Y.O., M.O., E.U., T.K., N.O., T.N., M.I., T.M., K.K.).
authors.forename: Yoko
authors.initials: Y
authors.lastname: Okada
authors.affiliation: From the Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan (Y.T., T.M., F.M.); and Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan (Y.T., Y.O., M.O., E.U., T.K., N.O., T.N., M.I., T.M., K.K.).
authors.forename: Maya
authors.initials: M
authors.lastname: Ohara
authors.affiliation: From the Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan (Y.T., T.M., F.M.); and Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan (Y.T., Y.O., M.O., E.U., T.K., N.O., T.N., M.I., T.M., K.K.).
authors.forename: Eri
authors.initials: E
authors.lastname: Uetani
authors.affiliation: From the Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan (Y.T., T.M., F.M.); and Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan (Y.T., Y.O., M.O., E.U., T.K., N.O., T.N., M.I., T.M., K.K.).
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kido
authors.affiliation: From the Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan (Y.T., T.M., F.M.); and Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan (Y.T., Y.O., M.O., E.U., T.K., N.O., T.N., M.I., T.M., K.K.).
authors.forename: Namiko
authors.initials: N
authors.lastname: Ochi
authors.affiliation: From the Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan (Y.T., T.M., F.M.); and Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan (Y.T., Y.O., M.O., E.U., T.K., N.O., T.N., M.I., T.M., K.K.).
authors.forename: Tokihisa
authors.initials: T
authors.lastname: Nagai
authors.affiliation: From the Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan (Y.T., T.M., F.M.); and Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan (Y.T., Y.O., M.O., E.U., T.K., N.O., T.N., M.I., T.M., K.K.).
authors.forename: Michiya
authors.initials: M
authors.lastname: Igase
authors.affiliation: From the Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan (Y.T., T.M., F.M.); and Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan (Y.T., Y.O., M.O., E.U., T.K., N.O., T.N., M.I., T.M., K.K.).
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Miki
authors.affiliation: From the Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan (Y.T., T.M., F.M.); and Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan (Y.T., Y.O., M.O., E.U., T.K., N.O., T.N., M.I., T.M., K.K.).
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Matsuda
authors.affiliation: From the Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan (Y.T., T.M., F.M.); and Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan (Y.T., Y.O., M.O., E.U., T.K., N.O., T.N., M.I., T.M., K.K.).
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Kohara
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D001921:Brain / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D059168:Carotid Intima-Media Thickness; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000473:pathology; D059345:Cerebral Small Vessel Diseases / Q000453:epidemiology / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000473:pathology; D003072:Cognition Disorders / Q000453:epidemiology / Q000473:pathology; D060825:Cognitive Dysfunction / Q000453:epidemiology* / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D004856:Postural Balance; D012678:Sensation Disorders / Q000453:epidemiology*; D059409:Stroke, Lacunar / Q000453:epidemiology* / Q000473:pathology
keywords: lacunar; stroke