WHITE-MATTER LESIONS AND DISEQUILIBRIUM IN OLDER-PEOPLE .1. CASE-CONTROL COMPARISON

Objective: To investigate the relationship between subcortical white matter lesions identified on magnetic resonance imaging and gait and balance problems in older people. Design: Magnetic resonance imaging scans of the brain in 27 community-dwelling older patients (> 75 years of age) who had subjective and objective abnormalities of gait and balance of unknown cause were compared with those of 27 age- and sex-matched control subjects. The T-2-weighted intense lesions of the subcortical white matter: were graded on a scale of 0 to 2. Setting: Outpatient clinic. Results: The patients had significantly (P < .01, chi(2)) more severe subcortical white matter hyperintensities on magnetic resonance imaging than did the control group. Patients fell more frequently than did the control subjects and had slower motor responses and prolonged reaction times compared with the control subjects. Conclusions: Subcortical white matter lesions identified on magnetic resonance imaging are associated with gait and balance dysfunction in ambulatory older people. These lesions probably interfere with central processing of sensorimotor signals leading to impaired postural responses.