Abstract
ObjectivesThis study assesses the whole brain microstructural integrity of white matter tracts (WMT) among older individuals with a history of falls compared to non-fallers.Methods85 participants (43 fallers, 42 non-fallers) were evaluated with conventional MRI and diffusion tensor imaging (DTI) sequences of the brain. DTI metrics were obtained from selected WMT using tract-based spatial statistics (TBSS) method. This was followed by binary logistic regression to investigate the clinical variables that could act as confounding elements on the outcomes. The TBSS analysis was then repeated, but this time including all significant predictor variables from the regression analysis as TBSS covariates.ResultsThe mean diffusivity (MD) and axial diffusivity (AD) and to a lesser extent radial diffusivity (RD) values of the projection fibers and commissural bundles were significantly different in fallers (p < 0.05) compared to non-fallers. However, the final logistic regression model obtained showed that only functional reach, white matter lesion volume, hypertension and orthostatic hypotension demonstrated statistical significant differences between fallers and non-fallers. No significant differences were found in the DTI metrics when taking into account age and the four variables as covariates in the repeated analysis.ConclusionThis DTI study of 85 subjects, do not support DTI metrics as a singular factor that contributes independently to the fall outcomes. Other clinical and imaging factors have to be taken into account.
Highlights
Falls are common in the older population
The mean diffusivity (MD) and axial diffusivity (AD) and to a lesser extent radial diffusivity (RD) values of the projection fibers and commissural bundles were significantly different in fallers (p < 0.05) compared to non-fallers
The final logistic regression model obtained showed that only functional reach, white matter lesion volume, hypertension and orthostatic hypotension demonstrated statistical significant differences between fallers and non-fallers
Summary
Falls are common in the older population. The annual incidence of falls is nearly 30% in individuals 65 years and above and the number is expected to increase further as the population ages [1]. Falls in older people lead to physical disability, psychosocial problems, deterioration in quality of life and reduced survival [2, 3]. It often results in hospitalization and institutionalization with expensive medical costs [4]. In the LADIS study, Baezner et al (2008) concluded that a strong association exists between the severity of age-related white matter (WM) changes with gait and motor compromise [7]. A recent diffusion tensor imaging (DTI) study reveals that in older subjects with small vessel disease, disruption of WM integrity in both (a) WML that appears as hyperintensities on T2-weighted MRI images as well as (b) “normal-appearing WM”, are associated with gait disturbances [9]. DTI enables us to detect loss of integrity even in the “normal-appearing WM” on conventional MRI images
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