Research

Sub-cortical infarcts and the risk of falls in older people: combined results of TASCOG and Sydney MAS studies

Corresponding Author

Michele L. Callisaya

Department of Medicine, Southern Clinical School, Monash Medical Centre, Monash University, Melbourne, Australia

Menzies Research Institute, University of Tasmania, Hobart, Australia

Correspondence: Michele L. Callisaya, Southern Clinical School, Monash Medical Centre, Level 5, Block E, 246 Clayton Road, Clayton, Vic. 3168, Australia.

E-mail: [email protected]

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Velandai K. Srikanth,

Velandai K. Srikanth

Department of Medicine, Southern Clinical School, Monash Medical Centre, Monash University, Melbourne, Australia

Menzies Research Institute, University of Tasmania, Hobart, Australia

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Stephen R. Lord,

Stephen R. Lord

Neuroscience Research Australia, University of New South Wales, Sydney, Australia

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Jacqueline C. Close,

Jacqueline C. Close

Neuroscience Research Australia, University of New South Wales, Sydney, Australia

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Henry Brodaty,

Henry Brodaty

School of Psychiatry, University of New South Wales, Sydney, Australia

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Perminder S. Sachdev,

Perminder S. Sachdev

Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, Sydney, Australia

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Thanh Phan,

Thanh Phan

Department of Medicine, Southern Clinical School, Monash Medical Centre, Monash University, Melbourne, Australia

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Richard Beare,

Richard Beare

Department of Medicine, Southern Clinical School, Monash Medical Centre, Monash University, Melbourne, Australia

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Julian Trollor,

Julian Trollor

School of Psychiatry, University of New South Wales, Sydney, Australia

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Wei Wen,

Wei Wen

School of Psychiatry, University of New South Wales, Sydney, Australia

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Jacqueline J. Zheng,

Jacqueline J. Zheng

Neuroscience Research Australia, University of New South Wales, Sydney, Australia

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Kim Delbaere,

Kim Delbaere

Neuroscience Research Australia, University of New South Wales, Sydney, Australia

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Michele L. Callisaya,

Corresponding Author

Michele L. Callisaya

Department of Medicine, Southern Clinical School, Monash Medical Centre, Monash University, Melbourne, Australia

Menzies Research Institute, University of Tasmania, Hobart, Australia

Correspondence: Michele L. Callisaya, Southern Clinical School, Monash Medical Centre, Level 5, Block E, 246 Clayton Road, Clayton, Vic. 3168, Australia.

E-mail: [email protected]

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Velandai K. Srikanth,

Velandai K. Srikanth

Department of Medicine, Southern Clinical School, Monash Medical Centre, Monash University, Melbourne, Australia

Menzies Research Institute, University of Tasmania, Hobart, Australia

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Stephen R. Lord,

Stephen R. Lord

Neuroscience Research Australia, University of New South Wales, Sydney, Australia

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Jacqueline C. Close,

Jacqueline C. Close

Neuroscience Research Australia, University of New South Wales, Sydney, Australia

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Henry Brodaty,

Henry Brodaty

School of Psychiatry, University of New South Wales, Sydney, Australia

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Perminder S. Sachdev,

Perminder S. Sachdev

Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, Sydney, Australia

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Thanh Phan,

Thanh Phan

Department of Medicine, Southern Clinical School, Monash Medical Centre, Monash University, Melbourne, Australia

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Richard Beare,

Richard Beare

Department of Medicine, Southern Clinical School, Monash Medical Centre, Monash University, Melbourne, Australia

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Julian Trollor,

Julian Trollor

School of Psychiatry, University of New South Wales, Sydney, Australia

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Wei Wen,

Wei Wen

School of Psychiatry, University of New South Wales, Sydney, Australia

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Jacqueline J. Zheng,

Jacqueline J. Zheng

Neuroscience Research Australia, University of New South Wales, Sydney, Australia

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Kim Delbaere,

Kim Delbaere

Neuroscience Research Australia, University of New South Wales, Sydney, Australia

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First published: 08 April 2014

https://doi.org/10.1111/ijs.12279

Conflicts of interest: There are no conflicts of interest.

Funding: MAS: This study received Australian NHMRC grant (grant number 400941). S. R. Lord is currently an NHMRC Senior Principal Research Fellow and K. Delbaere is an NHMRC Career Development Fellow. The Memory and Ageing Study of the Brain and Ageing Program, School of Psychiatry, UNS, is funded by an NHMRC Program Grant (grant number 350833) to Professors P. S. Sachdev and H. Brodaty.

TASCOG: This study received grants from National Health and Medical Research Council (grant number 403000 BH); Physiotherapy Research Foundation (grant number BH036/05); Perpetual Trustees; Brain Foundation; Royal Hobart Hospital Research Foundation (grant number 341M); and ANZ Charitable Trust and Masonic Centenary Medical Research Foundation. V. K. Srikanth is funded by an NHMRC/National Heart Foundation Career Development Award (606544). M. L. Callisaya is funded by an NHMRC Early Career Fellowship (1034483).

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Abstract

Background

White matter hyperintensities increase the risk of multiple falls in older people, but the effect of sub-cortical infarcts is unknown.

Aims

By pooling data from two Australian population-based studies, we aimed to investigate the association between sub-cortical infarcts and multiple falls and whether this relationship, and that of white matter hyperintensities, is mediated or modified by cognitive or sensorimotor factors.

Methods

Participants underwent structural magnetic resonance imaging and cognitive and sensorimotor assessments. Falls were prospectively measured over 12 months. Sub-cortical infarcts were detected visually. Total white matter hyperintensity volume was quantified using automated segmentation methods. Generalized linear models were used to examine if sub-cortical infarcts and white matter hyperintensities predicted falls.

Results

The mean age of the sample (n = 655) was 74·5 (standard deviation 6·7) years, 336 (51·3%) males. Overall, 114 (17·4%) had multiple falls. The majority had no sub-cortical infarcts (n = 491, 75·0%), while 90 had one (13·7%), 41 had two (6·3%), and 33 had more than or equal to three sub-cortical infarcts (5·0%). The risk of multiple falls was elevated in people with more than or equal to three sub-cortical infarcts (adjusted relative risk 1·89, 95% confidence interval 1·03, 3·46) and in the highest quarter of white matter hyperintensity volume (adjusted relative risk 1·46, 95% confidence interval 1·00, 2·13). The effect of sub-cortical infarcts on falls was amplified by poorer vision (P = 0·03). The effect of white matter hyperintensities was amplified by poorer vision (P = 0·008), proprioception (P = 0·03), and muscle strength (P = 0·008). There was no modifying effect of cognitive function.

Conclusions

Increasing burdens of sub-cortical infarcts and white matter hyperintensities are associated with a risk of falling. Interventions targeting sensorimotor factors along with strategies to prevent sub-cortical infarcts and white matter hyperintensities may reduce the risk of falls.

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Volume9, IssueA100

Special Issue:World Stroke Day Edition 2014

October 2014

Pages 55-60

Sub-cortical infarcts and the risk of falls in older people: combined results of TASCOG and Sydney MAS studies

Abstract

Background

Aims

Methods

Results

Conclusions

References

References

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Sub-cortical infarcts and the risk of falls in older people: combined results of TASCOG and Sydney MAS studies

Abstract

Background

Aims

Methods

Results

Conclusions

References

References

Related

Information