TY - JOUR
T1 - Sub-cortical infarcts and the risk of falls in older people
T2 - Combined results of TASCOG and Sydney MAS studies
AU - Callisaya, Michele L.
AU - Srikanth, Velandai K.
AU - Lord, Stephen R.
AU - Close, Jacqueline C.
AU - Brodaty, Henry
AU - Sachdev, Perminder S.
AU - Phan, Thanh
AU - Beare, Richard
AU - Trollor, Julian
AU - Wen, Wei
AU - Zheng, Jacqueline J.
AU - Delbaere, Kim
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Background: White matter hyperintensities increase the risk of multiple falls in older people, but the effect of sub-cortical infarcts is unknown. Aims: By pooling data from two Australian population-based studies, we aimed to investigate the association between sub-cortical infarcts and multiple falls and whether this relationship, and that of white matter hyperintensities, is mediated or modified by cognitive or sensorimotor factors. Methods: Participants underwent structural magnetic resonance imaging and cognitive and sensorimotor assessments. Falls were prospectively measured over 12 months. Sub-cortical infarcts were detected visually. Total white matter hyperintensity volume was quantified using automated segmentation methods. Generalized linear models were used to examine if sub-cortical infarcts and white matter hyperintensities predicted falls. Results: The mean age of the sample (n=655) was 74·5 (standard deviation 6·7) years, 336 (51·3%) males. Overall, 114 (17·4%) had multiple falls. The majority had no sub-cortical infarcts (n=491, 75·0%), while 90 had one (13·7%), 41 had two (6·3%), and 33 had more than or equal to three sub-cortical infarcts (5·0%). The risk of multiple falls was elevated in people with more than or equal to three sub-cortical infarcts (adjusted relative risk 1·89, 95% confidence interval 1·03, 3·46) and in the highest quarter of white matter hyperintensity volume (adjusted relative risk 1·46, 95% confidence interval 1·00, 2·13). The effect of sub-cortical infarcts on falls was amplified by poorer vision (P=0·03). The effect of white matter hyperintensities was amplified by poorer vision (P=0·008), proprioception (P=0·03), and muscle strength (P=0·008). There was no modifying effect of cognitive function. Conclusions: Increasing burdens of sub-cortical infarcts and white matter hyperintensities are associated with a risk of falling. Interventions targeting sensorimotor factors along with strategies to prevent sub-cortical infarcts and white matter hyperintensities may reduce the risk of falls.
AB - Background: White matter hyperintensities increase the risk of multiple falls in older people, but the effect of sub-cortical infarcts is unknown. Aims: By pooling data from two Australian population-based studies, we aimed to investigate the association between sub-cortical infarcts and multiple falls and whether this relationship, and that of white matter hyperintensities, is mediated or modified by cognitive or sensorimotor factors. Methods: Participants underwent structural magnetic resonance imaging and cognitive and sensorimotor assessments. Falls were prospectively measured over 12 months. Sub-cortical infarcts were detected visually. Total white matter hyperintensity volume was quantified using automated segmentation methods. Generalized linear models were used to examine if sub-cortical infarcts and white matter hyperintensities predicted falls. Results: The mean age of the sample (n=655) was 74·5 (standard deviation 6·7) years, 336 (51·3%) males. Overall, 114 (17·4%) had multiple falls. The majority had no sub-cortical infarcts (n=491, 75·0%), while 90 had one (13·7%), 41 had two (6·3%), and 33 had more than or equal to three sub-cortical infarcts (5·0%). The risk of multiple falls was elevated in people with more than or equal to three sub-cortical infarcts (adjusted relative risk 1·89, 95% confidence interval 1·03, 3·46) and in the highest quarter of white matter hyperintensity volume (adjusted relative risk 1·46, 95% confidence interval 1·00, 2·13). The effect of sub-cortical infarcts on falls was amplified by poorer vision (P=0·03). The effect of white matter hyperintensities was amplified by poorer vision (P=0·008), proprioception (P=0·03), and muscle strength (P=0·008). There was no modifying effect of cognitive function. Conclusions: Increasing burdens of sub-cortical infarcts and white matter hyperintensities are associated with a risk of falling. Interventions targeting sensorimotor factors along with strategies to prevent sub-cortical infarcts and white matter hyperintensities may reduce the risk of falls.
KW - Falls
KW - Older people
KW - Population based
KW - Small vessel disease
KW - Sub-cortical infarcts
KW - White matter disease
UR - http://www.scopus.com/inward/record.url?scp=84912045996&partnerID=8YFLogxK
U2 - 10.1111/ijs.12279
DO - 10.1111/ijs.12279
M3 - Article
C2 - 24712920
AN - SCOPUS:84912045996
SN - 1747-4930
VL - 9
SP - 55
EP - 60
JO - International Journal of Stroke
JF - International Journal of Stroke
IS - A100
ER -