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Cerebrovascular hemodynamics, gait, and falls in an elderly population: MOBILIZE Boston Study
F A Sorond1, A Galica, J M Serrador
1Department of Neurology, Stroke Division, Brigham and Women's Hospital, 45 Francis St., Boston, MA 02115, USA. fsorond@partners.org
Insights
Impaired cerebral blood flow regulation, specifically cerebral vasoreactivity to CO(2), is linked to slower walking speeds and an increased risk of falls in older adults.
Area of Science:
- Neurology
- Gerontology
- Cardiovascular Physiology
Background:
- Cerebral blood flow regulation is crucial for maintaining brain function.
- Alterations in cerebral blood flow may contribute to mobility decline in the elderly.
- Gait speed and falls are significant indicators of health and independence in older adults.
Purpose of the Study:
- To investigate the association between cerebral blood flow regulation and gait speed.
- To determine if impaired cerebral blood flow regulation predicts fall rates in community-dwelling seniors.
Main Methods:
- Utilized transcranial Doppler ultrasound to measure cerebral blood flow velocity in 419 elderly individuals.
- Assessed cerebral vasoreactivity to CO(2) and cerebral autoregulation during sit-to-stand maneuvers.
- Measured gait speed and tracked fall incidence over time.
Main Results:
- Cerebral vasoreactivity to CO(2) was significantly associated with slower gait speed.
- Individuals with the lowest vasoreactivity had significantly slower gait speeds.
- A trend towards a higher fall rate was observed in those with the lowest cerebral vasoreactivity.
Conclusions:
- Impaired cerebral vasoreactivity to CO(2) is associated with reduced gait speed in the elderly.
- This impairment may be a contributing factor to the development of falls in older populations.
Objective:
To determine whether alterations in cerebral blood flow regulation are associated with slow gait speed and falls in community-dwelling elderly individuals.
Methods:
The study sample consisted of 419 individuals from the MOBILIZE Boston Study (MBS) who had transcranial Doppler ultrasound measures of cerebral blood flow velocity. The MBS is a prospective cohort study of a unique set of risk factors for falls in seniors in the Boston area. We measured beat-to-beat blood flow velocity in the middle cerebral artery in response to 1) changes in end-tidal CO(2) (cerebral vasoreactivity) and 2) blood pressure changes during a sit-to-stand protocol (cerebral autoregulation). Gait speed was measured during a 4-meter walk. Falls were tracked by monthly calendars, and demographic and clinical characteristics were assessed at baseline.
Results:
A multivariate linear regression analysis showed that cerebral vasoreactivity was cross-sectionally related to gait speed (p = 0.039). Individuals in the lowest quintile of vasoreactivity had lower gait speeds as compared to those in the highest quintile (p = 0.047). In a negative binomial regression analysis adjusted for relevant covariates, the relationship between cerebral vasoreactivity and fall rate did not reach significance. However, when comparing individuals in the lowest to highest quintile of cerebral vasoreactivity, those in the lowest quintile had a higher fall rate (p = 0.029).
Conclusions:
Impaired cerebral blood flow regulation, as measured by cerebral vasoreactivity to CO(2), is associated with slow gait speed and may lead to the development of falls in elderly people.
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