Neurological abnormalities predict disability: the LADIS (Leukoaraiosis And DISability) study
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Neurological abnormalities predict disability : the LADIS (Leukoaraiosis And DISability) study. / Poggesi, Anna; Gouw, Alida; van der Flier, Wiesje; Pracucci, Giovanni; Chabriat, Hugues; Erkinjuntti, Timo; Fazekas, Franz; Ferro, José M; Blahak, Christian; Langhorne, Peter; O'Brien, John; Schmidt, Reinhold; Visser, Marieke C; Wahlund, Lars-Olof; Waldemar, Gunhild; Wallin, Anders; Scheltens, Philip; Inzitari, Domenico; Pantoni, Leonardo.
I: Journal of Neurology, Bind 261, Nr. 6, 06.2014, s. 1160-1169.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
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
Y1 - 2014/6
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.
KW - Activities of Daily Living
KW - Aged
KW - Aged, 80 and over
KW - Disability Evaluation
KW - Disabled Persons
KW - Europe
KW - Female
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
VL - 261
SP - 1160
EP - 1169
JO - Deutsche Zeitschrift fur Nervenheilkunde
JF - Deutsche Zeitschrift fur Nervenheilkunde
SN - 0939-1517
IS - 6
ER -
ID: 138549512