Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort

Domenico Inzitari; Giovanni Pracucci; Anna Poggesi; Giovanna Carlucci; Frederik Barkhof; Hugues Chabriat; Timo Erkinjuntti; Franz Fazekas; José M Ferro; Michael Hennerici; Peter Langhorne; John O'Brien; Philip Scheltens; Marieke C Visser; Lars-Olof Wahlund; Gunhild Waldemar; Anders Wallin; Leonardo Pantoni; LADIS Study Group

Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort

Domenico Inzitari, Giovanni Pracucci, Anna Poggesi, Giovanna Carlucci, Frederik Barkhof, Hugues Chabriat, Timo Erkinjuntti, Franz Fazekas, José M Ferro, Michael Hennerici, Peter Langhorne, John O'Brien, Philip Scheltens, Marieke C Visser, Lars-Olof Wahlund, Gunhild Waldemar, Anders Wallin, Leonardo Pantoni, LADIS Study Group

264 Citations (Scopus)

Abstract

OBJECTIVE: To assess the impairment in daily living activities in older people with age related changes in white matter according to the severity of these changes. DESIGN: Observational data collection and follow-up of a cohort of older people undergoing brain magnetic resonance imaging after non-disabling complaints. SETTING: 11 European centres. PARTICIPANTS: 639 non-disabled older patients (mean age 74.1 (SD 5.0), 45.1% men) in whom brain magnetic resonance imaging showed mild, moderate, or severe age related changes in white matter (Fazekas scale). Magnetic resonance imaging assessment also included cerebral infarcts and atrophy. MAIN OUTCOME MEASURE: Transition from no disability (defined as a score of 0 or 1 on the instrumental activities of daily living scale) to disability (score >/=2) or death over three year follow-up. Secondary outcomes were incident dementia and stroke. RESULTS: Over a mean follow-up period of 2.42 years (SD 0.97, median 2.94 years), information on the main outcome was available for 633 patients. The annual rate of transition or death was 10.5%, 15.1%, and 29.5%, respectively, for patients with mild, moderate, or severe age related changes in white matter (Kaplan-Meier log rank test P<0.001). In a Cox model comparing severe with mild changes and adjusted for clinical factors of functional decline, the risk of transition to disability or death was more than twofold higher (hazard ratio 2.36, 95% confidence interval 1.65 to 3.81). The other predictors were age group, history of atrial fibrillation, and complaint of gait disturbances. The effect of severe changes remained significant independently of baseline degree of atrophy and number of infarcts. Incident stroke and dementia only slightly modified this effect. CONCLUSION: The three year results of the LADIS study suggest that in older adults who seek medical attention for non-disabling complaints, severe age related changes in white matter independently and strongly predict rapid global functional decline.

Original language	English
Journal	BMJ. British Medical Journal (International Ed.)
Volume	339
Pages (from-to)	b2477
ISSN	0959-8146
Publication status	Published - 2009

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Inzitari, D., Pracucci, G., Poggesi, A., Carlucci, G., Barkhof, F., Chabriat, H., Erkinjuntti, T., Fazekas, F., Ferro, J. M., Hennerici, M., Langhorne, P., O'Brien, J., Scheltens, P., Visser, M. C., Wahlund, L-O., Waldemar, G., Wallin, A., Pantoni, L., & LADIS Study Group (2009). Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort. BMJ. British Medical Journal (International Ed.), 339, b2477.

Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort. / Inzitari, Domenico; Pracucci, Giovanni; Poggesi, Anna et al.

In: BMJ. British Medical Journal (International Ed.), Vol. 339, 2009, p. b2477.

Research output: Contribution to journal › Journal article › Research › peer-review

Inzitari, D, Pracucci, G, Poggesi, A, Carlucci, G, Barkhof, F, Chabriat, H, Erkinjuntti, T, Fazekas, F, Ferro, JM, Hennerici, M, Langhorne, P, O'Brien, J, Scheltens, P, Visser, MC, Wahlund, L-O, Waldemar, G, Wallin, A, Pantoni, L & LADIS Study Group 2009, 'Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort', BMJ. British Medical Journal (International Ed.), vol. 339, pp. b2477.

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title = "Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort",

abstract = "OBJECTIVE: To assess the impairment in daily living activities in older people with age related changes in white matter according to the severity of these changes. DESIGN: Observational data collection and follow-up of a cohort of older people undergoing brain magnetic resonance imaging after non-disabling complaints. SETTING: 11 European centres. PARTICIPANTS: 639 non-disabled older patients (mean age 74.1 (SD 5.0), 45.1% men) in whom brain magnetic resonance imaging showed mild, moderate, or severe age related changes in white matter (Fazekas scale). Magnetic resonance imaging assessment also included cerebral infarcts and atrophy. MAIN OUTCOME MEASURE: Transition from no disability (defined as a score of 0 or 1 on the instrumental activities of daily living scale) to disability (score >/=2) or death over three year follow-up. Secondary outcomes were incident dementia and stroke. RESULTS: Over a mean follow-up period of 2.42 years (SD 0.97, median 2.94 years), information on the main outcome was available for 633 patients. The annual rate of transition or death was 10.5%, 15.1%, and 29.5%, respectively, for patients with mild, moderate, or severe age related changes in white matter (Kaplan-Meier log rank test P<0.001). In a Cox model comparing severe with mild changes and adjusted for clinical factors of functional decline, the risk of transition to disability or death was more than twofold higher (hazard ratio 2.36, 95% confidence interval 1.65 to 3.81). The other predictors were age group, history of atrial fibrillation, and complaint of gait disturbances. The effect of severe changes remained significant independently of baseline degree of atrophy and number of infarcts. Incident stroke and dementia only slightly modified this effect. CONCLUSION: The three year results of the LADIS study suggest that in older adults who seek medical attention for non-disabling complaints, severe age related changes in white matter independently and strongly predict rapid global functional decline.",

author = "Domenico Inzitari and Giovanni Pracucci and Anna Poggesi and Giovanna Carlucci and Frederik Barkhof and Hugues Chabriat and Timo Erkinjuntti and Franz Fazekas and Ferro, {Jos{\'e} M} and Michael Hennerici and Peter Langhorne and John O'Brien and Philip Scheltens and Visser, {Marieke C} and Lars-Olof Wahlund and Gunhild Waldemar and Anders Wallin and Leonardo Pantoni and {LADIS Study Group}",

note = "Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Brain; Cerebral Infarction; Cohort Studies; Dementia; Disabled Persons; Female; Humans; Kaplan-Meiers Estimate; Leukoaraiosis; Magnetic Resonance Imaging; Male; Referral and Consultation; Risk Factors; Stroke",

year = "2009",

language = "English",

volume = "339",

pages = "b2477",

journal = "The BMJ",

issn = "0959-8146",

publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort

AU - Inzitari, Domenico

AU - Pracucci, Giovanni

AU - Poggesi, Anna

AU - Carlucci, Giovanna

AU - Barkhof, Frederik

AU - Chabriat, Hugues

AU - Erkinjuntti, Timo

AU - Fazekas, Franz

AU - Ferro, José M

AU - Hennerici, Michael

AU - Langhorne, Peter

AU - O'Brien, John

AU - Scheltens, Philip

AU - Visser, Marieke C

AU - Wahlund, Lars-Olof

AU - Waldemar, Gunhild

AU - Wallin, Anders

AU - Pantoni, Leonardo

AU - LADIS Study Group

N1 - Keywords: Activities of Daily Living; Aged; Aged, 80 and over; Brain; Cerebral Infarction; Cohort Studies; Dementia; Disabled Persons; Female; Humans; Kaplan-Meiers Estimate; Leukoaraiosis; Magnetic Resonance Imaging; Male; Referral and Consultation; Risk Factors; Stroke

PY - 2009

Y1 - 2009

N2 - OBJECTIVE: To assess the impairment in daily living activities in older people with age related changes in white matter according to the severity of these changes. DESIGN: Observational data collection and follow-up of a cohort of older people undergoing brain magnetic resonance imaging after non-disabling complaints. SETTING: 11 European centres. PARTICIPANTS: 639 non-disabled older patients (mean age 74.1 (SD 5.0), 45.1% men) in whom brain magnetic resonance imaging showed mild, moderate, or severe age related changes in white matter (Fazekas scale). Magnetic resonance imaging assessment also included cerebral infarcts and atrophy. MAIN OUTCOME MEASURE: Transition from no disability (defined as a score of 0 or 1 on the instrumental activities of daily living scale) to disability (score >/=2) or death over three year follow-up. Secondary outcomes were incident dementia and stroke. RESULTS: Over a mean follow-up period of 2.42 years (SD 0.97, median 2.94 years), information on the main outcome was available for 633 patients. The annual rate of transition or death was 10.5%, 15.1%, and 29.5%, respectively, for patients with mild, moderate, or severe age related changes in white matter (Kaplan-Meier log rank test P<0.001). In a Cox model comparing severe with mild changes and adjusted for clinical factors of functional decline, the risk of transition to disability or death was more than twofold higher (hazard ratio 2.36, 95% confidence interval 1.65 to 3.81). The other predictors were age group, history of atrial fibrillation, and complaint of gait disturbances. The effect of severe changes remained significant independently of baseline degree of atrophy and number of infarcts. Incident stroke and dementia only slightly modified this effect. CONCLUSION: The three year results of the LADIS study suggest that in older adults who seek medical attention for non-disabling complaints, severe age related changes in white matter independently and strongly predict rapid global functional decline.

AB - OBJECTIVE: To assess the impairment in daily living activities in older people with age related changes in white matter according to the severity of these changes. DESIGN: Observational data collection and follow-up of a cohort of older people undergoing brain magnetic resonance imaging after non-disabling complaints. SETTING: 11 European centres. PARTICIPANTS: 639 non-disabled older patients (mean age 74.1 (SD 5.0), 45.1% men) in whom brain magnetic resonance imaging showed mild, moderate, or severe age related changes in white matter (Fazekas scale). Magnetic resonance imaging assessment also included cerebral infarcts and atrophy. MAIN OUTCOME MEASURE: Transition from no disability (defined as a score of 0 or 1 on the instrumental activities of daily living scale) to disability (score >/=2) or death over three year follow-up. Secondary outcomes were incident dementia and stroke. RESULTS: Over a mean follow-up period of 2.42 years (SD 0.97, median 2.94 years), information on the main outcome was available for 633 patients. The annual rate of transition or death was 10.5%, 15.1%, and 29.5%, respectively, for patients with mild, moderate, or severe age related changes in white matter (Kaplan-Meier log rank test P<0.001). In a Cox model comparing severe with mild changes and adjusted for clinical factors of functional decline, the risk of transition to disability or death was more than twofold higher (hazard ratio 2.36, 95% confidence interval 1.65 to 3.81). The other predictors were age group, history of atrial fibrillation, and complaint of gait disturbances. The effect of severe changes remained significant independently of baseline degree of atrophy and number of infarcts. Incident stroke and dementia only slightly modified this effect. CONCLUSION: The three year results of the LADIS study suggest that in older adults who seek medical attention for non-disabling complaints, severe age related changes in white matter independently and strongly predict rapid global functional decline.

M3 - Journal article

C2 - 19581317

SN - 0959-8146

VL - 339

SP - b2477

JO - The BMJ

JF - The BMJ

ER -

Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort

Abstract

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