Neurological abnormalities predict disability: the LADIS (Leukoaraiosis And DISability) study

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• 作者：Anna Poggesi (1)
  Alida Gouw (2)
  Wiesje van der Flier (2)
  Giovanni Pracucci (1)
  Hugues Chabriat (3)
  Timo Erkinjuntti (4)
  Franz Fazekas (5)
  José M. Ferro (6)
  Christian Blahak (7)
  Peter Langhorne (8)
  John O’Brien (9)
  Reinhold Schmidt (5)
  Marieke C. Visser (2)
  Lars-Olof Wahlund (10)
  Gunhild Waldemar (11)
  Anders Wallin (12)
  Philip Scheltens (2)
  Domenico Inzitari (1)
  Leonardo Pantoni (13)
  
• 关键词：White matter changes ; Disability ; Cerebrovascular diseases ; Neurological examination ; MRI
• 刊名：Journal of Neurology
• 出版年：2014
• 出版时间：June 2014
• 年：2014
• 卷：261
• 期：6
• 页码：1160-1169
• 全文大小：
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• 作者单位：Anna Poggesi (1)
  Alida Gouw (2)
  Wiesje van der Flier (2)
  Giovanni Pracucci (1)
  Hugues Chabriat (3)
  Timo Erkinjuntti (4)
  Franz Fazekas (5)
  José M. Ferro (6)
  Christian Blahak (7)
  Peter Langhorne (8)
  John O’Brien (9)
  Reinhold Schmidt (5)
  Marieke C. Visser (2)
  Lars-Olof Wahlund (10)
  Gunhild Waldemar (11)
  Anders Wallin (12)
  Philip Scheltens (2)
  Domenico Inzitari (1)
  Leonardo Pantoni (13)
  
  1. Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
  2. Department of Radiology and Neurology, VU Medical Centre, Amsterdam, The Netherlands
  3. Department of Neurology, Hopital Lariboisiere, Paris, France
  4. Memory Research Unit, Department of Clinical Neurosciences, Helsinki University, Helsinki, Finland
  5. Department of Neurology, Medical University, Graz, Austria
  6. Servi?o de Neurologia, Centro de Estudos Egas Moniz, Hospital de Santa Maria Lisboa, Lisbon, Portugal
  7. Department of Neurology, Universitaets Medizin Mannheim, University of Heidelberg, Mannheim, Germany
  8. Academic Department for Geriatric Medicine, Glasgow Royal Infirmary, Glasgow, UK
  9. Institute for Ageing and Health, University of Newcastle, Newcastle upon Tyne, UK
  10. Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Huddinge University Hospital, Huddinge, Sweden
  11. Department of Neurology, Memory Disorders Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
  12. Institute of Clinical Neuroscience, Goteborg University, G?teborg, Sweden
  13. Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
  
• ISSN：1432-1459

文摘

To investigate the role of neurological abnormalities and magnetic resonance imaging (MRI) lesions in predicting global functional decline in a cohort of initially independent-living elderly subjects. The Leukoaraiosis And DISability (LADIS) Study, involving 11 European centres, was primarily aimed at evaluating age-related white matter changes (ARWMC) as an independent predictor of the transition to disability (according to Instrumental Activities of Daily Living scale) or death in independent elderly subjects that were followed up for 3?years. At baseline, a standardized neurological examination was performed. MRI assessment included age-related white matter changes (ARWMC) grading (mild, moderate, severe according to the Fazekas-scale), count of lacunar and non-lacunar infarcts, and global atrophy rating. Of the 633 (out of the 639 enrolled) patients with follow-up information (mean age 74.1?±?5.0?years, 45?% males), 327 (51.7?%) presented at the initial visit with ? neurological abnormality and 242 (38?%) reached the main study outcome. Cox regression analyses, adjusting for MRI features and other determinants of functional decline, showed that the baseline presence of any neurological abnormality independently predicted transition to disability or death [HR (95?% CI) 1.53 (1.01-.34)]. The hazard increased with increasing number of abnormalities. Among MRI lesions, only ARWMC of severe grade independently predicted disability or death [HR (95?% CI) 2.18 (1.37-.48)]. In our cohort, presence and number of neurological examination abnormalities predicted global functional decline independent of MRI lesions typical of the aging brain and other determinants of disability in the elderly. Systematically checking for neurological examination abnormalities in older patients may be cost-effective in identifying those at risk of functional decline.