Brain White Matter Hyperintensities, Executive Dysfunction, Instability, and Falls in Older People: A Prospective Cohort Study

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Abstract
White matter hyperintensities (WMHs) are associated with fall risk factors in older people including reduced cognitive functioning and impaired balance and gait. This prospective study investigated relationships between WMHs, sensorimotor performance, executive functioning, and falls in a large sample of community-living older people. Two hundred and eighty-seven community-dwelling people aged 70–90 years, underwent structural magnetic resonance imaging and assessments of executive function (Trail-Making Tests), sensorimotor performance (Physiological Profile Assessment), and prospective monitoring of falls. Total WMH volume was quantified using an automated method. Fallers were defined as people who had at least one injurious or two noninjurious falls during the 12-month follow-up period. Participants with severe WMH burden (WMH volumes as a percentage of intracranial volume in the fourth quartile) performed poorly in the Trail-Making Test and Physiological Profile Assessment (p < .05) and had an increased risk of falls during the 12-month follow-up (relative risk = 1.63, 95% confidence interval 1.11–2.40). The association between WMHs and falls was little changed after adjusting for Trail-Making Test and Physiological Profile Assessment scores, age, sex, education, and a range of cardiovascular risk factors (relative risk = 1.55, 95% confidence interval 1.06–2.26). Greater WMH burden predicts falls over 12 months, and the association between greater burden of WMHs and falls appears to be independent of reduced executive function and sensorimotor performance. Strategies to reduce the development and progression of WMHs may contribute to future falls prevention in older people.

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