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White matter hyperintensities are associated with falls in older people with dementia

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Abstract

White Matter Hyperintensities (WMHs) are associated with impaired gait, balance and cognition and increased fall risk in cognitively healthy older people. However, few studies have examined such relationships in older people with dementia. Understanding the role of WMHs in falls may assist in developing effective fall prevention strategies. We investigated the relationship between baseline WMHs, cognitive and sensorimotor function and prospective falls in older people with dementia. Twenty-eight community-dwelling older people with mild-moderate dementia (MMSE 11–23; ACE-R < 83) underwent magnetic resonance imaging and assessment of sensorimotor and cognitive (global and processing speed) function at baseline. WMHs, were quantified using a fully automated segmentation toolbox, UBO Detector (https://cheba.unsw.edu.au/group/neuroimaging-pipeline). Falls were ascertained prospectively for 12-months using monthly calendars with the assistance of carers. The median age of the participants was 83 years (IQR 77–86); 36% were female; 21 (75%) fell during follow-up. Using Generalized Linear Models, larger volumes of total WMHs were found to be significantly associated with poorer global cognitive and sensorimotor function. Using modified Poisson regression, total, periventricular and deep WMHs were each associated with future falls while controlling for age, sex, intracranial volume and vascular risk. Each standard deviation increase in total and periventricular WMH volume resulted in a 33% (RR 1.33 95%CI 1.07–1.66) and 30% (RR 1.30 95%CI 1.06–1.60) increased risk of falling, respectively. When the deep WMH volume z-scores were dichotomized at the median, individuals with greater deep WMH volumes had an 81% (RR 1.81 95% CI 1.02–3.21) increased risk of falling. WMHs were associated with poorer sensorimotor and cognitive function in people with dementia and total, periventricular and deep WMHs were associated with falls. Further research is needed to confirm these preliminary findings and explore the impact of vascular risk reduction strategies on WMHs, functional performance and falls.

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Funding

This work was supported by the Australian National Health and Medical Research Council (NHMRC) (grant number 455368) and the NHMRC Cognitive Decline Partnership Centre (grant number 9100000). This manuscript does not reflect the views of the NHMRC or funding partners. Dr. Morag Taylor is a NHMRC-Australian Research Council Dementia Research Development Fellow. A/Prof Kim Delbaere is a NHMRC Career Development Fellow. Prof Stephen Lord is a NHMRC Senior Principal Research Fellow.

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Correspondence to Morag E. Taylor.

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The Physiological Profile Assessment (FallScreen) is commercially available through Neuroscience Research Australia (NeuRA). Professor Henry Brodaty holds a position on the advisory board for Nutricia.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individuals, and their person responsible, included in the study.

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Taylor, M.E., Lord, S.R., Delbaere, K. et al. White matter hyperintensities are associated with falls in older people with dementia. Brain Imaging and Behavior 13, 1265–1272 (2019). https://doi.org/10.1007/s11682-018-9943-8

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  • DOI: https://doi.org/10.1007/s11682-018-9943-8

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