Diffusion tensor imaging, white matter lesions, the corpus callosum, and gait in the elderly

Authors: BHADELIA, REFFEEQUE - Tufts - New England Medical Center; PRICE, LORI LYN - Tufts - New England Medical Center; TEDESCO, KURTIS - Tufts - New England Medical Center; SCOTT, TAMMY - Tufts - New England Medical Center; QIU, WEI QIAO - Tufts - New England Medical Center; PATZ, SAMUEL - Tufts - New England Medical Center; FOLSTEIN, MARSHAL - Tufts University; ROSENBERG, IRWIN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; CAPLAN, LOUIS - Beth Israel Deaconess Medical Center; BERGETHON, PETER - Tufts - New England Medical Center

Submitted to: Stroke
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/27/2009
Publication Date: 10/1/2009
Citation: Bhadelia, R.A., Price, L., Tedesco, K.L., Scott, T., Qiu, W., Patz, S., Folstein, M., Rosenberg, I.H., Caplan, L., Bergethon, P. 2009. Diffusion tensor imaging white matter lesions the corpus callosum and gait in the elderly. Stroke. 40:3816-3820.

Interpretive Summary: Movement problems are common in the elderly, especially those associated with stroke and defects in brain wiring that are visible in conventional brain magnetic resonance imaging (MRI). Diffusion tensor imaging (DTI) is more sensitive to detecting defects in brain wiring than conventional MRI. The relationship between DTI measures and movement has not been previously studied. Our purpose was to investigate the relationship between normal brain wiring in a specific part of the brain as determined by DTI and quantitative measures of movement in the elderly. One hundred seventy three participants of a house-bound elderly cohort underwent neurological and neuropsychological examinations and brain MRI. Conventional MRI was used to evaluate for stroke and the amount of brain defects in brain wiring. The independent association between quantitative measures of movement and DTI findings show that brain wiring integrity in a specific part of the brain is an important marker of movement in the elderly. DTI analyses of brain wiring defects in the brain and spinal cord may improve knowledge about the progression from normal movement to problems of movement and help target clinical interventions.

Technical Abstract: Gait impairment is common in the elderly, especially affected by stroke and white matter hyper intensities found in conventional brain magnetic resonance imaging (MRI). Diffusion tensor imaging (DTI) is more sensitive to white matter damage than conventional MRI. The relationship between DTI measures and gait has not been previously evaluated. Our purpose was to investigate the relationship between the integrity of white matter in the corpus callosum as determined by DTI and quantitative measures of gait in the elderly. One hundred seventy three participants of a community-dwelling elderly cohort underwent neurological and neuropsychological examinations and brain MRI. Gait function was measured by Tinetti gait (0 to 12), balance (0 to 16) and total (0 to 28) scores. DTI assessed fractional anisotropy in the genu and splenium of the corpus callosum. Conventional MRI was used to evaluate brain infarcts and white matter hyper intensity volume. Participants with abnormal gait had low fractional anisotropy in the genu of the corpus callosum but not the splenium. Multiple regression analyses showed an independent association between these genu abnormalities and all 3 Tinetti scores (P<0.001). This association remained significant after adding MRI infarcts and white matter hyper intensity volume to the analysis. The independent association between quantitative measures of gait function and DTI findings shows that white matter integrity in the genu of corpus callosum is an important marker of gait in the elderly. DTI analyses of white matter tracts in the brain and spinal cord may improve knowledge about the pathophysiology of gait impairment and help target clinical interventions.