WHITE-MATTER LESIONS AND DISEQUILIBRIUM IN OLDER-PEOPLE .1. CASE-CONTROL COMPARISON

Objective: To investigate the relationship between subcortical white m atter lesions identified on magnetic resonance imaging and gait and ba lance problems in older people. Design: Magnetic resonance imaging sca ns of the brain in 27 community-dwelling older patients (> 75 years of age) who had subjective and objective abnormalities of gait and balan ce of unknown cause were compared with those of 27 age- and sex-matche d control subjects. The T-2-weighted intense lesions of the subcortica l white matter: were graded on a scale of 0 to 2. Setting: Outpatient clinic. Results: The patients had significantly (P < .01, chi(2)) more severe subcortical white matter hyperintensities on magnetic resonanc e imaging than did the control group. Patients fell more frequently th an did the control subjects and had slower motor responses and prolong ed reaction times compared with the control subjects. Conclusions: Sub cortical white matter lesions identified on magnetic resonance imaging are associated with gait and balance dysfunction in ambulatory older people. These lesions probably interfere with central processing of se nsorimotor signals leading to impaired postural responses.