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• W1600542971 abstract "To the Editor: In their article recently published in the Journal of the American Geriatrics Society,1 Rosano et al. found that subclinical structural brain abnormalities (i.e., ventricular enlargement, white matter hyperintensities, subcortical and basal ganglia small brain infarcts) in high-functioning older adults can increase the risk of developing physical disabilities and declining in motor performances. Because of the clinical relevance and the prognostic implications of this topic, we decided to investigate the risk of declining motor performance in a similar population using a low-cost neuroimaging tool (computed tomography (CT) of the brain) to detect subcortical vascular disease (SVD, white matter hyperintensities, subcortical and basal ganglia small brain infarcts) Between January 2003 and January 2004, 349 patients were consecutively admitted to our Rehabilitation and Aged Care Unit after orthopedic surgery (n=82) or as a consequence of stroke (n=25), Parkinson's disease (n=31), and gait and balance disorders (n=211). All underwent a multidimensional assessment including sociodemographics (age, sex, living conditions), nutritional and somatic status (body mass index, Charlson Index, number of drugs on admission and at discharge, and presence of diabetes mellitus and ischemic heart disease), cognitive status (Mini-Mental State Examination (MMSE)), affective disorders (Geriatric Depression Scale (GDS)), and functional status (Barthel Index). The Barthel Index from 1 month before admission was compared with the Barthel Indexes at admission and discharge. The presence and severity of cortical, white-matter, and deep subcortical lesions and of leukoariosis were assessed on CT film with a standardized visual rating scale, which has been previously validated and used in elderly patients.2,3 Of the 349 patients, 217 (62.2%) had a Barthel Index at discharge greater than 80/100, indicating a high-functioning level. At 12 months, 14 (6.5%) of these subjects had died. For subjects who were still alive, information about two specific items of Barthel Index—12-month transfer and walking abilities—was gathered using phone interviews. A sumscore for these items was created to measure mobility and walking performance at discharge and at 12 months, and the difference between the discharge and 12-month sumscores was computed; patients were therefore stratified in two groups according to change in functional status (difference in sumscore <1 denoted improvement or stability, whereas difference in sumscore≥1 denoted decline). Table 1 shows that SVD (P=.009); age (P<.005); comorbidity (Charlson Index, P=.002); and cognitive (MMSE, P=.002), affective (GDS, P=.002), and functional status (Barthel Index before admission, P=.01, and Barthel Index at discharge, P=.02) were significantly different in the two groups. Our findings support those of Rosano et al. that SVD, in addition to other typical variables of geriatric assessment, is associated with functional decline in high-functioning older patients. Alternatively, they suggest that brain CT may be useful in predicting long-term outcomes and accurate. In rehabilitation, barriers to widespread neuroimaging use include costs and availability of diagnostic tools.4 From this perspective, CT may be viewed as a valid option. Financial Disclosure: None. Author Contributions: All authors contributed to the study concept and design, acquisition of subjects, and data analysis. Sponsor's Role: None." @default.
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• W1600542971 date "2005-10-01" @default.
• W1600542971 modified "2023-10-16" @default.
• W1600542971 title "SUBCORTICAL VASCULAR DISEASE DETECTED WITH COMPUTED TOMOGRAPHY AND 1-YEAR PHYSICAL DECLINE IN HIGH-FUNCTIONING OLDER ADULTS" @default.
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• W1600542971 doi "https://doi.org/10.1111/j.1532-5415.2005.53528_8.x" @default.
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