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Abstract
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More than four decades ago, Professor Bernard Isaacs postulated in this journal that to attribute falls in older individuals only to muscular-articular and sensory impairments and their effect on gait and balance was overly simplistic [1]. Rather, a failure of our sophisticated system of brain motor control plays a capital role in triggering falls [2].
Since his seminal article, clinical and research evidence have established that brain motor control of gait arises from specific cortical and subcortical brain areas and networks that share complex cognitive functions, such as executive function (Figure 1). Due to their particular watershed vascularisation (border-zone regions in the brain supplied by the major cerebral arteries where blood supply is decreased), these shared brain networks are highly susceptible to microvascular ischemia and the effects of hypertension that, when damaged, may lead to both gait impairments and falls and to severe cognitive decline [3]. Thus, white matter hyperintensities (WMH) may impair gait performance directly, by disrupting motor-related networks, or indirectly, by disrupting networks responsible for executive function that is fundamental for high-attentional motor control of gait.
Key Points
Editorial to accompany: Gait and falls in cerebral small vessel disease: a systematic review and meta-analysis [5].
Vascular brain burden, evaluated as white matter hyperintensities (WMH), is associated with gait disorders and falls in older adults.
Intensive hypertension management can reverse WMH, opening an opportunity for preventing 'brain failure' in older adults.
Gait disorders and falls in older adults may be prevented by treating covert cerebrovascular disease and hypertension.
Language: en |