Covert brain infarcts and white matter hyperintensities linked to increased fall risks: AHA

A new study published in the journal of Stroke showed that white-matter hyperintensity (WMH) abnormalities and hidden brain infarcts are revealed by CT and MR neuroimaging, and they seem to be linked to an increased risk of falls.

It is unknown how hidden cerebrovascular disease affects falls in the general population. Thus, to ascertain the time to a first fall after a concealed cerebrovascular disease was unintentionally discovered during a clinical neuroimaging event, Úna Clancy and colleagues carried out this investigation. With the exception of patients who had previously experienced a stroke or dementia, this study evaluated CT and MRI from 2009 to 2019 in patients over 50 who were enrolled with Kaiser Permanente Southern California.

Using natural language processing, this research was able to extract evidence of white matter hyperintensities/hypoattenuation (WMH) and incidental covert brain infarcts (CBI) from imaging data. Using Cox proportional hazards regression models that adjusted for 12 factors, such as age, sex, multimorbidity, ethnicity, polypharmacy, and incontinence, this research investigated the relationships between CBI and WMH and falls that required medical treatment.

Over a mean follow-up period of 3.04 years, this study evaluated 2,41,050 individuals with a mean age of 64.9 (SD, 10.42) years, 61.3% of whom were female, and 31.1% of whom had hidden cerebrovascular disease. During follow-up, 21.2% (51,239,241,050) experienced a reported decline. Individuals with both CBI and WMH had the greatest single fall incidence rate/1000 person-years (p-y) on CT (129.3 falls/1000 p-y [95% CI, 123.4–135.5]), followed by WMH (109.9 falls/1000 p-y [108.0–111.9]).

Both CBI and WMH had the greatest incidence rate on MRI (76.3 falls/1000 p-y [95% CI, 69.7–83.2]), with CBI coming in second (71.4 falls/1000 p-y [95% CI, 65.9–77.2]). In patients with CBI, the adjusted hazard ratio for a single index decline on CT was 1.13 (95% CI, 1.09–1.17), whereas on magnetic resonance imaging it was 1.17 (95% CI, 1.08–1.27). For mild (1.37 [95% CI, 1.32–1.43]), moderate (1.57 [95% CI, 1.48–1.67]), or severe WMH (1.57 [95% CI, 1.45–1.70]), the chance for a single index decline on CT rose progressively.

With increasing WMH severity on magnetic resonance imaging, the index fall risk also rose: mild WMH (1.11 [95% CI, 1.07–1.17]), moderate WMH (1.21 [95% CI, 1.13–1.28]), and severe WMH (1.34 [95% CI, 1.22–1.46]). Overall, both CBI and WMH are independently linked to increased chances of an index decline in a large population with neuroimaging.

Source:

Clancy, Ú., Puttock, E. J., Chen, W., Whiteley, W., Vickery, E. M., Leung, L. Y., Luetmer, P. H., Kallmes, D. F., Fu, S., Zheng, C., Liu, H., & Kent, D. M. (2025). Association of covert cerebrovascular disease with falls requiring medical attention. Stroke; a Journal of Cerebral Circulation. https://doi.org/10.1161/STROKEAHA.124.050137