London, United Kingdom 2013 11 Small vessel stroke and white matter disease What factors mediate or modify the association between white matter hyperintensities (WMH) and falls - pooled analysis of TASCOG and Sydney MAS M.L. Callisaya1, V.K. Srikanth2, S.R. Lord3, H. Brodaty4, P.S. Sachdev5, T.G. Phan6, R. Beare7, J.N. Trollor8, W. Wen9, J.J. Zheng10, K. Delbaere11 Monash Medical Centre - Monash University, Melbourne, AUSTRALIA1, Monash Medical Centre - Monash University, Melbourne, AUSTRALIA2, Neuroscience Research Australia - Univer-sity of New South Wales, Sydney, AUSTRALIA3, School of Psychiatry - University of New South Wales, Sydney, AUSTRALIA4, School of Psychiatry - University of New South Wales, Sydney, AUSTRALIA5, Monash Medical Centre - Monash University, Melbourne, AUSTRALIA6, Monash Medical Centre - Monash University, Melbourne, AUSTRALIA7, School of Psychiatry - Universi-ty of New South Wales, Sydney, AUSTRALIA8, School of Psychiatry - University of New South Wales, Sydney, AUSTRALIA9, Neuroscience Research Australia - University of New South Wales, Sydney, AUSTRALIA10, Neuro-science Research Australia - University of New South Wales, Sydney, AUSTRALIA11 Background: WMH increase the risk of falls in older people. However, it is unknown which cog-nitive or physical factors mediate or modify this relationship. We pooled data from two Australian population-based studies (TASCOG, MAS) to identify such factors with sufficient statistical power. Methods: Community-dwelling people randomly selected from the electoral roll underwent struc-tural MRI, cognitive and physiological assessments, and prospective monitoring of falls over 12 months. Total WMH volume was quantified using an automated method. Log multinomial regres-sion was used to estimate the relative risk of single and multiple falls associated with WMH adjust-ing for age, sex, education, total intracranial volume, study sample and vascular risk factors. In final models, cognitive and physiological measures were examined as potential mediators or modifiers in this relationship. Results: The mean age of the sample (n=655) was 74.5 (SD 6.7) years with 336 (51.3%) males. Over 12 months, 160 participants (24.4%) reported one fall and 114 (17.4%) reported multiple falls. The risk of multiple falls was significantly elevated in people with WMH volumes in the highest quartile of its distribution (adjusted relative risk, 1.57; 95% CI, 1.09-2.25). None of the physiolog-ical or cognitive factors mediated this association. The effect of WMH on the risk of falls was am-plified by greater age (p=0.02), worse vision (p=0.005) poorer proprioception (p=0.04) and weaker muscle strength (p=0.04). Conclusions: Increased risk of falls was found for those with the highest burden of WMHs. Poorer vision, proprioception and muscle strength increased this risk, indicating that interventions targeting these factors along with strategies to slow WML progression may reduce the risk of falls. E-Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 243 10 Small vessel stroke and white matter disease Imaging Features Associated With Progression In Patients With Subcortical Stroke A. Del Bene1, S. Nannoni2, V. Palumbo3, F. Sottile4, L. Petrone5, G. Pracucci6, D. Inzitari7 Department of Neurological and Psychiatric Sciences, University of Florence, Florence, ITA-LY1, Department of Neurological and Psychiatric Sciences, University of Florence, Florence, ITA-LY2, Stroke Unit, Careggi Hospital, Florence, ITALY3, Department of Neuroscience, Psychiatric and Anesthesiological Sciences, University of Messina, Messina, ITALY4, Department of Neurological and Psychiatric Sciences, University of Florence, Florence, ITALY5, Department of Neurological and Psychiatric Sciences, University of Florence, Florence, ITALY6, Department of Neurological and Psychiatric Sciences, University of Florence, Florence, ITALY7 Background. Early progression of neurological deficit is not uncommon in patients with subcorti-cal strokes (SS) and may lead to poor outcome. Aim of this study was to describe imaging features associated with progression. Methods. A series of consecutive patients with SS admitted to our Stroke Unit was divided into progressive (P) and non progressive (NP) groups. Progression was de-fined as an increase of at least one point in the motor items of the NIHSS during the first 72 hours after stroke onset. The two groups were compared in terms of risk factors and imaging (CT/MRI) features (vascular territory, size and number of slices in which the lesion was visible, presence of severe leukoaraiosis). Factors associated with progression after univariate analysis were entered into a multiple logistic regression model. Results. Out of 79 patients included, 25 (32%) showed progression. Patients who progressed were more likely to have a lesion ≥15mm in diameter (52% vs 17%, p=0.001) and visible in ≥3 slices (67% vs 25%, p=0.001). Infarcts in the anterior choroidal artery territory (24/79) were about twofold more frequent in the P group than in the NP group (44% vs 24%, p=0.073) and more likely to extend ≥3 slices compared with other territories (58% vs 27%, p=0.010). After adjusting for demographics, risk factors, previous stroke and for the other imag-ing features, infarct width and length remained independently associated with progression with an OR=4.4 (95% CI 1.2-16.6) for a diameter ≥15mm and an OR=4.5 (95% CI 1.2-16.3) for lesions vis-ible ≥3 slices. The presence of severe leukoaraiosis was independently and strongly associated with neurological worsening (OR 5.8; 95% IC 1.1-30.4). Conclusion. Among subcortical infarcts those in the anterior choroidal artery territory are more likely to progress, and showed a more elongated shape compared to the others. We hypothesize that leukoaraiosis may contribute to lesion expansion owing to an impaired penumbral microcirculation.
Karger_ESC London_2013
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