Multiple balance tests improve the assessment of postural stability in subjects with Parkinson's disease

OBJECTIVES: Clinicians often base the implementation of therapies on the presence of postural instability in subjects with Parkinson's disease (PD). These decisions are frequently based on the pull test from the Unified Parkinson's Disease Rating Scale (UPDRS). We sought to determine whether combining the pull test, the one-leg stance test, the functional reach test, and UPDRS items 27-29 (arise from chair, posture, and gait) predicts balance confidence and falling better than any test alone. METHODS: The study included 67 subjects with PD. Subjects performed the one-leg stance test, the functional reach test, and the UPDRS motor exam. Subjects also responded to the Activities-specific Balance Confidence (ABC) scale and reported how many times they fell during the previous year. Regression models determined the combination of tests that optimally predicted mean ABC scores or categorised fall frequency. RESULTS: When all tests were included in a stepwise linear regression, only gait (UPDRS item 29), the pull test (UPDRS item 30), and the one-leg stance test, in combination, represented significant predictor variables for mean ABC scores (r2 = 0.51). A multinomial logistic regression model including the one-leg stance test and gait represented the model with the fewest significant predictor variables that correctly identified the most subjects as fallers or non-fallers (85% of subjects were correctly identified). CONCLUSIONS: Multiple balance tests (including the one-leg stance test, and the gait and pull test items of the UPDRS) that assess different types of postural stress provide an optimal assessment of postural stability in subjects with PD.     

Postural control in persons with late effects of polio

BACKGROUND: Persons who have suffered from acute poliomyelitis may decades later experience reduction of balance and gait capacity due to muscle weakness, fatigue and/or pain. This may affect the activity level in daily life of these persons. AIMS OF THE STUDY: The aim of this study was to describe observer assessed and subjectively perceived postural control in persons with late effects of polio and to evaluate the correlation between postural control and gait velocity for this population. METHOD: 50 persons (mean age 59.8 yrs) with diagnosed polio disease and without other causes of mobility disorders were included. Balance was tested with the Timed Up and Go test (TUG), the Functional Reach test (FR) and the Falls Efficacy Scale (FES) (Swedish Version). Gait velocity over 30 m was measured for convenient and maximal velocity. RESULTS: The subjects had reduced balance (TUG mean 9.0 sec, FR mean 23.5 cm) and perceived balance problems in ADL items (FES(S) median 119.5, normal value 130). They also showed reduced gait velocity compared to healthy persons of the same age (mean 1.01 m/s compared to 1.30 m/s, convenient speed). Correlations were demonstrated between the reduced balance and decreased convenient and maximal gait velocity (TUG/gait velocity: r = -0.7 (convenient), r = -0.8 (maximal), p 相似文献   

Reliability of spatiotemporal gait outcome measures in Huntington's disease.

Gait impairments are very important in Huntington's disease (HD), because loss of independence in gait is an important predictor of nursing home placement. Given this importance, it is imperative to test reliable and sensitive outcome measures that can be tested easily in various clinical environments. Here, we examined the test-retest reliability of gait outcome measures using the GAITRite instrumented carpet. We tested 12 subjects with HD and 12 age-matched controls in two separate sessions. At each session, subjects walked across the GAITRite carpet at a comfortable speed. We used the intraclass correlation coefficient (ICC) and coefficient of variation (CoV) to measure test-retest reliability. Reliability was very high for all outcome measures (velocity, cycle time, stride length, cadence, and base of support), as seen by high ICC scores (0.86 to 0.95) and low CoV scores (0.042-0.102). In addition, the performance across the two subject groups was very different, indicating that the GAITRite is sensitive enough to distinguish between populations. Given that the GAITRite is a relatively inexpensive and portable piece of equipment, it can be used in a wide variety of clinical settings and clinical trials. Our data on high test-retest reliability and sensitivity extends the utility of the GAITRite to the HD population.     

Construction and validation of the Dynamic Parkinson Gait Scale (DYPAGS)

The dynamic evaluation of Parkinson's disease (PD)-related episodic gait disturbances in routine is challenging. Therefore, the aim of our study was to assess the reliability/validity of the Dynamic Parkinson Gait Scale (DYPAGS) composed of eight relevant items for the objective quantification of PD gait features: walking forwards/backwards/with dual-task, turning to both sides, imaginary obstacle avoidance with both legs and passing through narrow spaces. The scale was validated on thirty-five patients with mild to severe parkinsonism in their habitual "on-state". A shorter 6 item-version was designed on the basis of a principal component analysis. No significant floor/ceiling effect was detected. The internal consistency was excellent. The levels of interrater agreement, precision and minimal detectable change were adequate. The criterion-related validity was demonstrated by strong correlations with the DYPAGS scores and those at the gait subscales of the Tinetti Mobility Test and MDS-UPDRS. The construct validity was assessed by moderate-strong correlations with the Freezing of Gait Questionnaire, mobility index of the PD Questionnaire (PDQ-39), disease duration and levodopa equivalent daily doses. Statistical analyses using the coefficient of determination showed that both DYPGAS versions were superior to the other instruments to identify patients with gait disturbances with poorer response to dopaminergic treatment. Full and short DYPAGS are reliable instruments for the quantification of "on" PD-related episodic gait disturbances. The full version is sensitive to detect subtle disturbances in mild parkinsonism. The shorter one is easily administered and reliably quantifies gait disturbances in moderate to severe parkinsonism. We recommend their use for research and clinical practice.     

Test-retest reliability of balance tests in children with cerebral palsy

To investigate intrasession and intersession reliability of balance tests in children with or without disabilities, 50 children without disabilities (ND) and 36 children with cerebral palsy (CP) aged from 5 to 12 years were tested. Intrasession reliability of postural stability of the Smart Balance Master System and one-leg standing test were assessed in both groups and intersession reliability of the Smart Balance Master System and balance subtest of the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) were assessed in ND children. Intersession reliability of the postural stability test in ND children, obtained using the Smart Balance Master System, was of moderate to good reliability in centre target (CT), sway vision (SV), eyes open and sway surface (EOSS), and sway vision and sway surface (SVSS; ICC 0.72 to 0.84). In children with CP, intrasession reliability was high in CT (ICC 1). One-leg standing tests in both groups also had moderate to good intersession reliability (ICC 0.56 to 0.99). Agreement of failure score of lateral rhythmic shifting (LRS) at 1 second and 2 seconds pace was 85% and 93% respectively in ND children. Within the balance subtest of BOTMP, only two items had 100% agreement. Results suggest that postural stability tests in four conditions (CT, SV, EOSS, and SVSS), LRS, one-leg standing, and walking on a line are reliable and can be used to monitor balance control in ND children. Postural stability in CT condition and one-leg standing test are reliable in children with CP. Further study is needed to establish more reliable balance tests for children with CP.     

Assessment of gait parameters and fatigue in MS patients during inpatient rehabilitation: a pilot trial

Gait impairment and fatigue are common and disabling problems in multiple sclerosis (MS). Characterisation of abnormal gait in MS patients has been done mainly using observational studies and simple walking tests providing only limited quantitative and no qualitative data, or using intricate and time-consuming assessment procedures. In addition, the correlation of gait impairments with fatigue is largely unknown. The aim of this study was to characterise spatio-temporal gait parameters by a simple and easy-to-use gait analysis system (GAITRite?) in MS patients compared with healthy controls, and to analyse changes and correlation with fatigue during inpatient rehabilitation. Twenty-four MS patients (EDSS <6.5) admitted for inpatient rehabilitation and 19 healthy subjects were evaluated using the GAITRite? Functional Ambulation System. Between-group differences and changes of gait parameters during inpatient rehabilitation were analysed, and correlation with fatigue, using the Wurzburg Fatigue Inventory for Multiple Sclerosis (WEIMuS), was determined. Compared to healthy controls MS patients showed significant impairments in different spatio-temporal gait parameters, which showed a significant improvement during inpatient rehabilitation. Different gait parameters were correlated with fatigue physical score, and change of gait parameters was correlated with improvement of fatigue. Spatio-temporal gait analysis is helpful to assess specific walking impairments in MS patients and subtle changes during rehabilitation. Correlation with fatigue may indicate a possible negative impact of fatigue on rehabilitation outcome.     

The Effect of Motor and Cognitive Tasks on Gait in People with Stroke

Objective: Gait of people with unilateral stroke is characterized by pronounced asymmetry. The aim of the study was to investigate the effect of cognitive and motor tasks on asymmetry of gait in people with stroke. Materials and Methods: Nine individuals with stroke walked over the GAITRite walkway while performing motor (holding a cup with water) or cognitive (reciting the alphabet) tasks or walked with no additional task. Gait velocity, cadence, and symmetry indexes for the stance phase, swing phase, and single support phase of a gait cycle were calculated. Results: The motor and cognitive tasks negatively affected gait velocity (P < .05) and cadence (P < .05). Walking and performing additional tasks resulted in the increase of the asymmetry of gait. The cognitive task had a greater effect on gait asymmetry than the motor task. Conclusions: The study outcome revealed that gait of individuals with stroke could be affected by simultaneous performance of additional tasks. The outcome provides a basis for future investigation of the ways of improving symmetry of gait in people with stroke.     

A video-based balance measure for people with intellectual disability

Abstract

Background?Many standardised balance measures are unsuitable for people who are unable to comprehend test requirements. We report on the development, administration, interrater reliability, and concurrent validity of a video-based balance measure for people with intellectual disability called the Balance Scale for Persons with Intellectual Disabilities.

Method?Video recordings of 25 people performing 7 common motor tasks, identified from stakeholder consultation, were made, and rated using standardised scoring criteria. Concurrent validity, assessed against the Tinetti Gait and Balance Instrument and the modified Gait Abnormality Rating Scale (GARS-M), and interrater reliability of the scale was evaluated with 19 physiotherapists.

Results?Scores suggested no ceiling or floor effects. Excellent interrater reliability (ICC?=?.9) was demonstrated. Concurrent validity was good against the Tinetti (ρ?=?.98) and the GARS-M (ρ?=??.87). Issues around lighting for video-recording and lack of steps or stairs in the home setting were encountered.

Conclusion?The new measure may be useful in trials assessing the effectiveness of interventions aimed at improving the balance capabilities of people with intellectual disability.     

暗示策略对帕金森病患者平衡功能和步态的康复作用

目的探讨暗示策略对帕金森病患者平衡功能和步态的康复作用。方法共40例原发性帕金森病患者随机接受常规抗帕金森病药物治疗和常规康复训练以及在此基础上联合暗示策略,分别于训练前和训练4周时采用Berg平衡量表(BBS)、10米步行试验(10MWT)、起立-行走计时测验(TUGT)和冻结步态问卷(FOGQ)评价平衡功能和步态,10MWT计算步长和步速。结果与训练前相比,训练4周时两组患者BBS评分(P=0.000)、10MWT之步长(P=0.000)和步速(P=0.000)均增加,TUGT时间(P=0.000)和FOGQ评分(P=0.000)减少;与对照组相比,观察组患者仅10MWT之步长(P=0.048)和步速(P=0.025)均增加、TUGT时间(P=0.023)和FOGQ评分(P=0.034)减少。结论常规康复训练联合暗示策略可以明显改善帕金森病患者平衡功能和步态,尤其对步态的康复治疗效果优于常规康复训练。     

早中期帕金森病患者平衡功能、跌倒风险及步态分析

目的分析早中期帕金森病患者平衡功能、跌倒风险和步态,以为其康复治疗提供临床依据。方法共30例早中期帕金森病患者和15例性别、年龄、受教育程度相匹配的正常对照者采用Berg平衡量表(BBS)评价平衡功能,起立-行走计时测验(TUGT)、站起测验(CRT)和走直线步态测验(TGT)评价跌倒风险,步态分析系统分析步态。结果与对照组相比,帕金森病组患者BBS评分减少(P=0.001)、TUGT时间(P=0.003)和CRT时间(P=0.002)延长、TGT正确步数减少(P=0.041),以及10米步行试验之步长缩短(P=0.020)、步速减慢(P=0.038)、足尖着地比例增加(P=0.000)、摆动相左侧和右侧踝背屈角度减小(P=0.005,0.006)。结论早中期帕金森病患者平衡功能下降、跌倒风险和步态异常风险增加,应早期予康复治疗。     

Quantitative gait,cognitive decline,and incident dementia: The Rotterdam Study

IntroductionPoor gait has recently emerged as a potential prodromal feature of cognitive decline and dementia. We assessed to what extent various aspects of poor gait are independently associated with cognitive decline and incident dementia.MethodsWe leveraged detailed quantitative gait (GAITRite™) and cognitive assessments in 4258 dementia-free participants (median age 67 years, 55% women) of the population-based Rotterdam Study (baseline 2009–2013). We summarized 30 gait parameters into seven mutually independent gait domains and a Global Gait score. Participants underwent follow-up cognitive assessments between 2014 and 2016 and were followed up for incident dementia until 2016 (median 4 years).ResultsThree independent gait domains (Base of Support, Pace, and Rhythm) and Global Gait were associated with cognitive decline. Two independent gait domains (Pace and Variability) and Global Gait were associated with incident dementia. Associations of gait with cognitive decline and incident dementia were only present in individuals who had been cognitively unimpaired at baseline.DiscussionPoor performance on several independent gait domains precedes cognitive decline and incident dementia.     

The diagnostic accuracy of selected neurological tests

The diagnostic value and reliability of selected neurological clinical tests was studied in control subjects with normal neuroimaging (n=42), and subjects with a focal brain lesion (n=38). The items were studied by two examiners blinded to group membership and using standardized protocols, and subsequently by a neurologist who was not blinded to diagnosis. The positive likelihood ratios ranged from 1.06 (pronator drift) to 22.11 (single leg stance with eyes open, while the negative likelihood ratios ranged from 0.47 (tandem gait) to 0.97 (pupil symmetry). Three items (single leg stance - eyes closed - firm surface; single leg stance - eyes open - foam surface; and tandem gait) successfully distinguished between the two groups (odds ratio p<0.05). The inter-rater reliability was generally poor, with only tandem gait showing excellent agreement (kappa [K]=0.92). Tandem gait was the only item to show noteworthy agreement (K=0.93) between the examiners and the neurologist. The tests varied considerably in their ability to detect radiologically demonstrated structural brain lesions, and several items were poorly reproducible, questioning their value as part of a routine neurological examination.     

Validity and test-retest reliability of a disability questionnaire for essential tremor.

BACKGROUND: One important outcome in clinical trials is patients' own opinions about whether the medication alleviates their symptoms and improves their ability to function. A valid and reliable method with which to assess this subjective information is important. OBJECTIVE: To determine the validity and test-retest reliability of the Columbia University Disability Questionnaire for Essential Tremor (ET). METHODS: Patients with ET underwent a 2.5-hour evaluation, including a 36-item tremor disability questionnaire, to assess the functional impact of tremor, a 26-item videotaped tremor examination rated by a neurologist, a 15-item performance-based test, and quantitative computerized tremor analysis. We determined the validity and test-retest reliability of the tremor disability questionnaire. Correlations between variables were assessed using Pearson's correlation coefficients and test-retest reliability with the weighted kappa statistic. RESULTS: Ninety-five patients with ET participated. The score on tremor disability questionnaire correlated with the neurologist's clinical ratings (r = 0.57, p <0.001) and the total score on the performance-based test (r = 0.69, p < 0.001). Correlations with quantitative computerized tremor analysis results were less robust, but each remained significant, including mean amplitude of dominant arm tremor while arms were extended (r = 0.56, p <0.001), while drawing a spiral (r = 0.42, p = 0.01), and while pouring (r = 0.34, p = 0.04). The questionnaire was readministered to 32 subjects, and the test-retest reliability was substantial (weighted kappa = 0.67). CONCLUSIONS: This Tremor Disability Questionnaire demonstrated substantial reliability, and it correlated with multiple measures of tremor severity, including a neurologist's clinical ratings, a performance-based test of function, and quantitative computerized tremor analysis results. The questionnaire would be useful in clinical trials in which it could be used as a reliable and valid tool to assess disability in ET.     

A Rating Scale for Gait Evaluation in Cognitive Deterioration (RSGE-CD): Validation Study

A relationship between decline in mobility and walking performance and cognitive impairment exists in the elderly. Therefore, clinical assessment of gait and mobility may be relevant for diagnostic and therapeutic purposes. However, the rating scales used for evaluation of gait disorder in the context of cognitive deterioration were not designed or validated for that setting. The present study was aimed at checking the clinimetric properties of the Rating Scale for Gait Evaluation in Cognitive Deterioration (RSGE-CD), specifically developed for assessment of gait dysfunction across all stages of cognitive decline. Two hundred fifty six subjects were included in the study and classified according to the Global Deterioration Scale (control, subjective/mild cognitive impairment, or dementia). Patients with dementia had a diagnosis of probable Alzheimer's disease (73%) or dementia of combined etiology (27%). Cognitive and functional evaluations, the Tinetti scale, and timed tests were simultaneously applied with the tested scale, which is composed of two subscales: Functional ability and Examination. Exploratory factor analysis showed one factor (70% of the variance). Floor effect and skewness were observed in the control group, whereas internal consistency (Cronbach's alpha = 0.88-0.95), inter-observer and test-retest reliability (intraclass correlation coefficients ≥0.97) were satisfactory. Convergent validity with the other measures was ≥0.60 and the discriminant validity according to classification of subjects by cognitive state and other aspects was also satisfactory (p = 0.0001). The RSGE-CD showed low standard errors of measurement. In this first validation study, the RSGE-CD showed satisfactory clinimetric attributes for assessing gait and mobility across the complete range of cognitive state.     

Spectrum of gait impairments in presymptomatic and symptomatic Huntington's disease

The purpose of this study was to quantify gait impairments in presymptomatic and symptomatic Huntington's disease (HD) subjects, and examine sensitivity of gait measures. Our sample (n = 65) included presymptomatic mutation carriers (PMC) (n = 15), symptomatic HD subjects (SHD) (n = 30) and healthy controls (n = 20). Participants were requested to walk at their preferred speed on a computerized walkway that recorded spatiotemporal variables. We administered the Unified HD Rating Scale (UHDRS) for PMC and SHD. PMC demonstrated decreased gait velocity (P < 0.01), stride length (P < 0.008), and increased time in double support (P < 0.001); and demonstrated higher variability in stride length (P < 0.01) and step time (P < 0.004) compared with controls. These impairments worsened with increasing disease severity for SHD. Gait impairments were correlated with predicted years to onset in PMC (velocity = ?0.65; cadence = ?0.70, step time = 0.71) and demonstrated high sensitivity and specificity in distinguishing between controls and mutation carriers. In contrast, UHDRS scores did not reveal impairments in gait and balance. Gait bradykinesia and dynamic balance impairments begin in the presymptomatic stage of HD and continue to worsen in the symptomatic stages. Gait measures are sensitive in differentiating between mutation positive and negative individuals even when impairments were not detected by clinical neurological examination. © 2008 Movement Disorder Society     

Does auditory rhythmical cueing improve gait in people with Parkinson's disease and cognitive impairment? A Feasibility study

Gait and balance problems resulting from Parkinson's disease (PD) are more common in people with PD and dementia (PDD), yet, it is unknown whether the benefits of cueing therapy for mobility generalize to them. We aimed to determine the feasibility and effectiveness of auditory cues to improve gait in PD and cognitive impairment (PD‐CI). Nine participants with PD‐CI walked with and without auditory cues using two different strategies: (1) Cue with temporal instruction to “step in time to the beat,” (2) Cue with spatiotemporal instruction to “take a big step in time to the beat.” Cues were delivered with a metronome at preferred stepping frequency while on medication during single and dual‐task gait. Gait was assessed using GAITRite and walking speed, stride amplitude, step frequency, and variability (CV%) of step and double limb support time were measured. Data were analyzed in SPSS version 16 using fixed‐effect linear mixed models. An adjusted, P value of 0.01 was considered significant. Participants were men, aged 74.89 (±6.45) years with median MMSE of 22 (range 20.5–25) and UPDRS III score of 44 (35.5–47.0). Participants complied with testing and instructions. The cue that focused attention on both temporal and spatial parameters of gait significantly improved single and dual‐task walking speed and stride amplitude. This study provides evidence for the potential of cueing to improve gait in PD‐CI. Only individuals with mild CI were included, and the effect with increased CI and different types of dementia requires further evaluation. © 2009 Movement Disorder Society     

Relating Parkinson freezing and balance domains: A structural equation modeling approach

BackgroundPeople with PD who exhibit freezing of gait (FOG) also exhibit poor balance compared to those who do not freeze. However, balance is a broad construct that can be subdivided into subdomains that include dynamic balance (gait), anticipatory postural adjustments (APAs) & gait initiation, postural sway in stance, and automatic postural responses (e.g., reactive stepping). Few studies have provided a robust investigation on how each of these domains is impacted by FOG, and no studies have compared balance across groups while rigorously controlling for disease severity.MethodsStructural equation modeling was used to evaluate the relationships between FOG and balance domains constructed as latent variables and controlling for disease severity. Domains included: dynamic balance (gait), APAs, postural sway, and reactive stepping. Models were run relating domains to both the presence and severity of FOG.ResultsLatent variables reflecting domains of Gait and APAs, but not postural sway or reactive stepping, were significantly related to the severity of FOG. Models for presence of FOG showed the same results, as Gait and APAs, but not postural sway or reactive stepping, were related to presence of FOG.ConclusionThese results are consistent with hypotheses that balance deficits in people with PD who freeze are most pronounced in gait and anticipatory postural adjustments. Reactive stepping and postural sway domains are less effected in PD patients who freeze compared to those who do not. These findings suggest that rehabilitative strategies focused on gait and APAs may be most effective for people with PD who freeze.     

Development and reliability of a pictorial mental disorders screen for young adolescents.

OBJECTIVE: To report psychometric data from preliminary studies of the Adolescent Dominic (AD), a pictorial screen for the most frequent Axis I youth mental disorders. METHODS: We created 113 picture items based on DSM-III-R diagnostic criteria and assessed them for comprehension (sample 1, n = 114; sample 2, n = 40) and reliability (sample 3, n = 128) in a group of adolescents aged 12 to 16 years living in the community. We used the kappa statistic to estimate test-retest reliability of symptoms, criteria and diagnoses, and intraclass correlation coefficients (ICCs) for symptom and criterion scores. We assessed internal consistency of symptom scores with the alpha coefficient. RESULTS: For symptoms, 54.4% of kappas were higher than 0.60, while only 2% were poor. ICCs for symptom scores yielded higher values (0.81 to 0.89) than for criterion scores (0.51 to 0.86). Internal consistency of symptom scores ranged from 0.52 to 0.83. Kappas for diagnoses ranged from 0.52 to 0.76. CONCLUSIONS: Symptom reliability compared favourably with data from other assessment interviews of youth mental disorders. Following these positive results, a computerized DSM-IV version of the AD has focused on the assessment of symptoms and is currently being tested for reliability and criterion validity.     

Quantitative evaluation of changes in gait after extended cerebrospinal fluid drainage for normal pressure hydrocephalus

Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait instability, urinary incontinence and cognitive dysfunction. These symptoms can be relieved by cerebrospinal fluid (CSF) drainage, but the time course and nature of the improvements are poorly characterized. Attempts to prospectively identify iNPH patients responsive to CSF drainage by evaluating presenting gait quality or via extended lumbar cerebrospinal fluid drainage (eLCD) trials are common, but the reliability of such approaches is unclear. Here we combine eLCD trials with computerized quantitative gait measurements to predict shunt responsiveness in patients undergoing evaluation for possible iNPH. In this prospective cohort study, 50 patients presenting with enlarged cerebral ventricles and gait, urinary, and/or cognitive difficulties were evaluated for iNPH using a computerized gait analysis system during a 3 day trial of eLCD. Gait speed, stride length, cadence, and the Timed Up and Go test were quantified before and during eLCD. Qualitative assessments of incontinence and cognition were obtained throughout the eLCD trial. Patients who improved after eLCD underwent ventriculoperitoneal shunt placement, and symptoms were reassessed serially over the next 3 to 15 months. There was no significant difference in presenting gait characteristics between patients who improved after drainage and those who did not. Gait improvement was not observed until 2 or more days of continuous drainage in most cases. Symptoms improved after eLCD in 60% of patients, and all patients who improved after eLCD also improved after shunt placement. The degree of improvement after eLCD correlated closely with that observed after shunt placement.     

A prospective study of cerebral white matter abnormalities in older people with gait dysfunction

OBJECTIVES: The authors previously reported cross-sectional data suggesting a relationship between cerebral white matter hyperintensities (WMH) and gait and balance dysfunction in older people. There have been no longitudinal MRI studies to address this issue. The current study compared progression of WMH in subjects with gait and balance dysfunction with that in healthy subjects. METHODS: Two brain MRI were performed on 70 healthy, ambulatory subjects (mean baseline age 79, range 74 to 88) with no identifiable neurologic disease. The mean time between MRI was 4 years. Gait and balance were quantified using the Tinetti Balance and Mobility Scale, and falls were documented each year. On T2-weighted MRI, total hyperintense volume (HV) within three periventricular levels was estimated using the Cavalieri principle, and WMH were graded (0 to 4) using an established semiquantitative scale. RESULTS: Compared with those with normal gait and balance, subjects whose Tinetti scores dropped markedly (> 4 points) between first and second MRI showed a significantly greater mean increase in HV during follow-up. The larger group of subjects with an abnormal Tinetti score (< 24) at the time of second MRI showed a significantly greater mean increase in HV, compared with those with normal gait and balance at follow-up. Subjects with marked WMH at baseline showed significantly greater increase in HV over time. Subjects with abnormal Tinetti scores had significantly more falls than subjects with normal Tinetti scores. CONCLUSIONS: Some older people develop gait and balance dysfunction that is associated with gradual onset of cerebral white matter disease.