Journal of Neurology

, Volume 261, Issue 6, pp 1160–1169 | Cite as

Neurological abnormalities predict disability: the LADIS (Leukoaraiosis And DISability) study

  • Anna Poggesi
  • Alida Gouw
  • Wiesje van der Flier
  • Giovanni Pracucci
  • Hugues Chabriat
  • Timo Erkinjuntti
  • Franz Fazekas
  • José M. Ferro
  • Christian Blahak
  • Peter Langhorne
  • John O’Brien
  • Reinhold Schmidt
  • Marieke C. Visser
  • Lars-Olof Wahlund
  • Gunhild Waldemar
  • Anders Wallin
  • Philip Scheltens
  • Domenico Inzitari
  • Leonardo PantoniEmail author
Original Communication


To investigate the role of neurological abnormalities and magnetic resonance imaging (MRI) lesions in predicting global functional decline in a cohort of initially independent-living elderly subjects. The Leukoaraiosis And DISability (LADIS) Study, involving 11 European centres, was primarily aimed at evaluating age-related white matter changes (ARWMC) as an independent predictor of the transition to disability (according to Instrumental Activities of Daily Living scale) or death in independent elderly subjects that were followed up for 3 years. At baseline, a standardized neurological examination was performed. MRI assessment included age-related white matter changes (ARWMC) grading (mild, moderate, severe according to the Fazekas’ scale), count of lacunar and non-lacunar infarcts, and global atrophy rating. Of the 633 (out of the 639 enrolled) patients with follow-up information (mean age 74.1 ± 5.0 years, 45 % males), 327 (51.7 %) presented at the initial visit with ≥1 neurological abnormality and 242 (38 %) reached the main study outcome. Cox regression analyses, adjusting for MRI features and other determinants of functional decline, showed that the baseline presence of any neurological abnormality independently predicted transition to disability or death [HR (95 % CI) 1.53 (1.01–2.34)]. The hazard increased with increasing number of abnormalities. Among MRI lesions, only ARWMC of severe grade independently predicted disability or death [HR (95 % CI) 2.18 (1.37–3.48)]. In our cohort, presence and number of neurological examination abnormalities predicted global functional decline independent of MRI lesions typical of the aging brain and other determinants of disability in the elderly. Systematically checking for neurological examination abnormalities in older patients may be cost-effective in identifying those at risk of functional decline.


White matter changes Disability Cerebrovascular diseases Neurological examination MRI 



The LADIS study was supported by the European Union within the Vth European Framework Program “Quality of life and management of living resources” (1998–2002) [contract No QLRT-2000-00446] as a concerted action.

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standard

This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Anna Poggesi
    • 1
  • Alida Gouw
    • 2
  • Wiesje van der Flier
    • 2
  • Giovanni Pracucci
    • 1
  • Hugues Chabriat
    • 3
  • Timo Erkinjuntti
    • 4
  • Franz Fazekas
    • 5
  • José M. Ferro
    • 6
  • Christian Blahak
    • 7
  • Peter Langhorne
    • 8
  • John O’Brien
    • 9
  • Reinhold Schmidt
    • 5
  • Marieke C. Visser
    • 2
  • Lars-Olof Wahlund
    • 10
  • Gunhild Waldemar
    • 11
  • Anders Wallin
    • 12
  • Philip Scheltens
    • 2
  • Domenico Inzitari
    • 1
  • Leonardo Pantoni
    • 13
    Email author
  1. 1.Neuroscience Section, NEUROFARBA DepartmentUniversity of FlorenceFlorenceItaly
  2. 2.Department of Radiology and NeurologyVU Medical CentreAmsterdamThe Netherlands
  3. 3.Department of NeurologyHopital LariboisiereParisFrance
  4. 4.Memory Research Unit, Department of Clinical NeurosciencesHelsinki UniversityHelsinkiFinland
  5. 5.Department of NeurologyMedical UniversityGrazAustria
  6. 6.Serviço de Neurologia, Centro de Estudos Egas MonizHospital de Santa Maria LisboaLisbonPortugal
  7. 7.Department of Neurology, Universitaets Medizin MannheimUniversity of HeidelbergMannheimGermany
  8. 8.Academic Department for Geriatric MedicineGlasgow Royal InfirmaryGlasgowUK
  9. 9.Institute for Ageing and HealthUniversity of NewcastleNewcastle upon TyneUK
  10. 10.Department of Clinical Neuroscience and Family Medicine, Karolinska InstituteHuddinge University HospitalHuddingeSweden
  11. 11.Department of Neurology, Memory Disorders Research UnitCopenhagen University HospitalCopenhagenDenmark
  12. 12.Institute of Clinical NeuroscienceGoteborg UniversityGöteborgSweden
  13. 13.Stroke Unit and NeurologyAzienda Ospedaliero Universitaria CareggiFlorenceItaly

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