Clinical prediction of fall risk and white matter abnormalities: a diffusion tensor imaging study

Area of Science:

• Neurology
• Geriatrics
• Radiology

Background:

• The Tinetti scale assesses fall risk in elderly individuals by evaluating gait and stance.
• Gait impairment in older adults is frequently associated with white matter (WM) abnormalities.
• Diffusion tensor imaging (DTI) is a neuroimaging technique used to study WM integrity.

Purpose of the Study:

• To investigate if elderly individuals identified as high fall risk by the Tinetti scale exhibit specific patterns of WM abnormalities on DTI.
• To correlate Tinetti scale scores with localized WM integrity measures.

Main Methods:

• A community-based cohort of 125 homebound elderly individuals was studied.
• Diffusion tensor imaging (DTI) was performed and analyzed using tract-based spatial statistics.
• Correlation analysis was used to associate Tinetti scale scores with fractional anisotropy (FA) values in WM.

Main Results:

• Subjects with a Tinetti scale score below 25 (indicating fall risk) showed WM abnormalities in several areas, including the medial frontal and parietal subcortical pathways, corpus callosum (genu and splenium), posterior cingulum, and fronto-temporo-parietal pathways.
• Abnormalities in the medial frontal and parietal subcortical pathways were correlated with Mini-Mental State Examination (MMSE) scores.
• Other identified WM abnormalities were not associated with cognitive scores.

Conclusions:

• Elderly individuals at increased risk for falls, as identified by the Tinetti scale, demonstrate specific white matter (WM) abnormalities detectable by diffusion tensor imaging (DTI).
• Certain WM abnormalities associated with fall risk in the elderly correlate with cognitive function, suggesting a link between gait, WM integrity, and cognition.