Original contribution
White matter hyperintensities and dynamics of postural control☆

https://doi.org/10.1016/j.mri.2009.01.010Get rights and content

Abstract

Background

White matter hyperintensities (WMHs) on MRI have been associated with age, cardiovascular risk factors and falls in the elderly. This study evaluated the relationship between WMHs and dynamics of postural control in older adults without history of falls.

Methods

We studied 76 community-living subjects without history of falls (age 64.5±7.3 years). Brain and WMH volume calculations and clinical rating were done on fluid-attenuation inversion recovery (FLAIR) and MP-RAGE MR images on 3 T. Balance was assessed from the center of pressure displacement using the force platform during 3 min of quiet standing using traditional and dynamic measures (using stabilogram-diffusion analysis). Gait speed was measured from 12-min walk.

Results

Age-adjusted periventricular and focal WMHs were associated with changes in certain dynamic balance measures, including reduced range of postural sway in anteroposterior direction (fronto-temporal WMHs, P=.045; parieto-occipital WMHs, P=.009) and more irregular long-term mediolateral fluctuations (P=.046). Normal walking speed was not affected by WMHs.

Conclusions

Periventricular and focal WMHs affect long-term dynamics of postural control, which requires engagement of feedback mechanisms, and may contribute to mobility decline in the elderly.

Introduction

White matter hyperintensities (WMHs) are seen as multifocal and/or diffuse hyperintense areas on T2-weighted brain MRIs of older people. WMHs have been related pathologically to cerebral microangiopathy [1], [2], hypoperfusion [3] and neuronal loss in affected areas [4], [5]. WMHs are strongly associated with age, hypertension and diabetes, thus supporting a vascular hypothesis of their origin. Clinical studies have suggested a link between WMHs and the age-related frontal lobe syndrome of cognitive decline [6], [7], balance disorders and falls [8]. Specifically, it appears that the fronto-temporal cortex [9] and periventricular white matter [10] are particularly vulnerable to hypoperfusion and the development of WMHs. Because of the close proximity of frontal-subcortical circuits that control both motor and cognitive functions, it would not be surprising that periventricular WMHs may simultaneously cause dysfunction in both systems and that neuroanatomical changes in these structures have consequences for memory, executive functions and balance in the older adults. We hypothesized that WMHs may affect feedback mechanisms controlling the dynamics of postural control. This study assessed the relationship between WMHs on MRI and postural control in community-living older people without history of falls.

Section snippets

Participants

Postural control assessment and MRI studies were conducted in the SAFE (Syncope and Falls in the Elderly) Laboratory and at the Magnetic Resonance Imaging Center at the Beth Israel Deaconess Medical Center (BIDMC) in a GE 3-T VHI scanner. We enrolled consecutively 104 participants, aged >50 years, who provided informed consent, approved by the Institutional Review Boards at the BIDMC and the Joslin Diabetes Center to participate in observational physiological studies about the effects of

Characteristics of study cohort

A total of 76 subjects completed MRI, gait and balance assessments (Table 1). Because of the known associations between WMHs, hypertension and diabetes, we also present separately the demographic characteristics for 38 normotensive (NTN) controls: 14 diabetic-normotensive (DM-NTN), 10 diabetic-hypertensive (DM-HTN) and 14 nondiabetic-hypertensive (HTN) participants. Whole brain and white matter volumes were not different among the groups. Participants with hypertension had greater normalized

Discussion

This study demonstrated that diffuse periventricular hyperintensities and ischemic punctuate lesions affect the dynamics of postural control in older adults without a history of falls. WMHs were associated with reduced range of postural sway in the anteroposterior direction and increased sway in the mediolateral direction and more random fluctuations in both directions, suggesting negative effects on postural control feedback mechanisms. Increased WMH load affected certain parameters of dynamic

Acknowledgments

We would like to acknowledge the contributions of the nurses from General Clinical Research Center; Sarah LaRose, BS, Laura DesRochers, BS, from the Division of Gerontology; Rob Marquise, BS, Fontini Kourtelidis, BS, and Susan LaRuche, BS, from the Radiology Department, Beth Israel Deaconess Medical Center, for their help with data acquisition.

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    ☆

    This study was supported by American Diabetes Association Grants 1-03-CR-23 and 1-06-CR-25, and NIH-NINDS 1R01-NS045745-01A2 to V. Novak, an NIH Older American Independence Center Grant 2P60 AG08812 and a General Clinical Research Center (GCRC) Grant MO1-RR01032.

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