Lower Body (Vascular) Parkinsonism

Abstract

To the Editor. —I was very interested in the recent article in theArchivesby Masdeu et al 1 on the correlation between white matter hypodensity on computed tomography (CT) and impaired gait and balance in the elderly. The investigators excluded orthopedic, cognitive, sensory, and other neurologic reasons for the ambulatory problems and falls. While the fallers (66.7% of 20) were more likely to be demented than the controls (25.0% of 20), and the dementia could have contributed to the poor balance, I agree with their conclusion that the periventricular white matter disease, suggested by the abnormal CT scans, was primarily responsible for the abnormal gait and falls. Although CT may be less sensitive than magnetic resonance imaging (MRI) for detection of white matter changes, these MRI changes may be seen also in normal individuals. 2 As noted by the authors, while the possible correlation between CT-MRI white matter changes