A prospective study of cerebral white matter abnormalities in older peoplewith gait dysfunction

Objectives: The authors previously reported cross-sectional data suggesting a relationship between cerebral white matter hyperintensities (WMH) and ga it and balance dysfunction in older people. There have been no longitudinal MRI studies to address this issue. The current study compared progression of WMH in subjects with gait and balance dysfunction with that in healthy s ubjects. Methods: Two brain MRI were performed on 70 healthy, ambulatory su bjects (mean baseline age 79, range 74 to 88) with no identifiable neurolog ic disease. The mean time between MRI was 4 years. Gait and balance were qu antified using the Tinetti Balance and Mobility Scale, and falls were docum ented each year. On T2-weighted MRI, total hyperintense volume (HV) within three periventricular levels was estimated using the Cavalieri principle, a nd WMH were graded (0 to 4) using an established semiquantitative scale. Re sults: Compared with those with normal gait and balance, subjects whose Tin etti scores dropped markedly (>4 points) between first and second MRI showe d a significantly greater mean increase in HV during follow-up. The larger group of subjects with an abnormal Tinetti score (< 24) at the time of seco nd MRI showed a significantly greater mean increase in HV, compared with th ose with normal gait and balance at follow-up. Subjects with marked WMH at baseline showed significantly greater increase in HV over time. Subjects wi th abnormal Tinetti scores had significantly more falls than subjects with normal Tinetti scores. Conclusions: Some older people develop gait and bala nce dysfunction that is associated with gradual onset of cerebral white mat ter disease.