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

Anna Poggesi; Alida Gouw; Wiesje van der Flier; Giovanni Pracucci; Hugues Chabriat; Timo Erkinjuntti; Franz Fazekas; José M Ferro; Christian Blahak; Peter Langhorne; John O'Brien; Reinhold Schmidt; Marieke C Visser; Lars-Olof Wahlund; Gunhild Waldemar; Anders Wallin; Philip Scheltens; Domenico Inzitari; Leonardo Pantoni

doi:10.1007/s00415-014-7332-9

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

Anna Poggesi, Alida Gouw, Wiesje van der Flier, Giovanni Pracucci, Hugues Chabriat, Timo Erkinjuntti, Franz Fazekas, José M Ferro, Christian Blahak, Peter Langhorne, John O'Brien, Reinhold Schmidt, Marieke C Visser, Lars-Olof Wahlund, Gunhild Waldemar, Anders Wallin, Philip Scheltens, Domenico Inzitari, Leonardo Pantoni

Department of Clinical Medicine

12 Citations (Scopus)

Abstract

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 ≥1 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 (1.01-2.34)]. 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 (1.37-3.48)]. 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.

Original language	English
Journal	Journal of Neurology
Volume	261
Issue number	6
Pages (from-to)	1160-1169
Number of pages	10
ISSN	0340-5354
DOIs	https://doi.org/10.1007/s00415-014-7332-9
Publication status	Published - Jun 2014

Keywords

Activities of Daily Living
Aged
Aged, 80 and over
Disability Evaluation
Disabled Persons
Europe
Female
Follow-Up Studies
Humans
Leukoaraiosis
Magnetic Resonance Imaging
Male
Nervous System Diseases
Neurologic Examination
Predictive Value of Tests
Proportional Hazards Models
Severity of Illness Index

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Poggesi, A., Gouw, A., van der Flier, W., Pracucci, G., Chabriat, H., Erkinjuntti, T., Fazekas, F., Ferro, J. M., Blahak, C., Langhorne, P., O'Brien, J., Schmidt, R., Visser, M. C., Wahlund, L-O., Waldemar, G., Wallin, A., Scheltens, P., Inzitari, D., & Pantoni, L. (2014). Neurological abnormalities predict disability: the LADIS (Leukoaraiosis And DISability) study. Journal of Neurology, 261(6), 1160-1169. https://doi.org/10.1007/s00415-014-7332-9

Poggesi, A, Gouw, A, van der Flier, W, Pracucci, G, Chabriat, H, Erkinjuntti, T, Fazekas, F, Ferro, JM, Blahak, C, Langhorne, P, O'Brien, J, Schmidt, R, Visser, MC, Wahlund, L-O, Waldemar, G, Wallin, A, Scheltens, P, Inzitari, D & Pantoni, L 2014, 'Neurological abnormalities predict disability: the LADIS (Leukoaraiosis And DISability) study', Journal of Neurology, vol. 261, no. 6, pp. 1160-1169. https://doi.org/10.1007/s00415-014-7332-9

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title = "Neurological abnormalities predict disability: the LADIS (Leukoaraiosis And DISability) study",

abstract = "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 ≥1 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 (1.01-2.34)]. 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 (1.37-3.48)]. 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.",

keywords = "Activities of Daily Living, Aged, Aged, 80 and over, Disability Evaluation, Disabled Persons, Europe, Female, Follow-Up Studies, Humans, Leukoaraiosis, Magnetic Resonance Imaging, Male, Nervous System Diseases, Neurologic Examination, Predictive Value of Tests, Proportional Hazards Models, Severity of Illness Index",

author = "Anna Poggesi and Alida Gouw and {van der Flier}, Wiesje and Giovanni Pracucci and Hugues Chabriat and Timo Erkinjuntti and Franz Fazekas and Ferro, {Jos{\'e} M} and Christian Blahak and Peter Langhorne and John O'Brien and Reinhold Schmidt and Visser, {Marieke C} and Lars-Olof Wahlund and Gunhild Waldemar and Anders Wallin and Philip Scheltens and Domenico Inzitari and Leonardo Pantoni",

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doi = "10.1007/s00415-014-7332-9",

language = "English",

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pages = "1160--1169",

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T1 - Neurological abnormalities predict disability

T2 - the LADIS (Leukoaraiosis And DISability) study

AU - Poggesi, Anna

AU - Gouw, Alida

AU - van der Flier, Wiesje

AU - Pracucci, Giovanni

AU - Chabriat, Hugues

AU - Erkinjuntti, Timo

AU - Fazekas, Franz

AU - Ferro, José M

AU - Blahak, Christian

AU - Langhorne, Peter

AU - O'Brien, John

AU - Schmidt, Reinhold

AU - Visser, Marieke C

AU - Wahlund, Lars-Olof

AU - Waldemar, Gunhild

AU - Wallin, Anders

AU - Scheltens, Philip

AU - Inzitari, Domenico

AU - Pantoni, Leonardo

PY - 2014/6

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N2 - 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 ≥1 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 (1.01-2.34)]. 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 (1.37-3.48)]. 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.

AB - 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 ≥1 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 (1.01-2.34)]. 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 (1.37-3.48)]. 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.

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KW - Aged

KW - Aged, 80 and over

KW - Disability Evaluation

KW - Disabled Persons

KW - Europe

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KW - Follow-Up Studies

KW - Humans

KW - Leukoaraiosis

KW - Magnetic Resonance Imaging

KW - Male

KW - Nervous System Diseases

KW - Neurologic Examination

KW - Predictive Value of Tests

KW - Proportional Hazards Models

KW - Severity of Illness Index

U2 - 10.1007/s00415-014-7332-9

DO - 10.1007/s00415-014-7332-9

M3 - Journal article

C2 - 24723116

SN - 0939-1517

VL - 261

SP - 1160

EP - 1169

JO - Deutsche Zeitschrift fur Nervenheilkunde

JF - Deutsche Zeitschrift fur Nervenheilkunde

IS - 6

ER -

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

Abstract

Keywords

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