Journal of Rehabilitation Research & Development (JRRD)

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JRRD Volume 46, Number 8, 2009

ages 1045 — 1052

Abstract — Age-associated striatal dopaminergic denervation and falls in community-dwelling subjects

Nicolaas I. Bohnen, MD, PhD;1-2* Martijn L. T. M. Muller, PhD;2 Hiroto Kuwabara, MD, PhD;3 Rakié Cham, PhD;4 Gregory M. Constantine, PhD;5 Stephanie A. Studenski, MD, MPH6-7

1Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Geriatric Research, Education, and Clinical Center (GRECC), Ann Arbor, MI; 2Functional Neuroimaging, Cognitive and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI; 3Department of Radiology, Johns Hopkins University, Baltimore, MD; Departments of  4Bioengineering and 5Mathematics and Statistics, University of Pittsburgh, Pittsburgh, PA; 6VA Pittsburgh Healthcare System, GRECC, Pittsburgh, PA; 7Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh Medical School, Pittsburgh, PA

Abstract — Older adults have a high prevalence of gait and balance disturbances and falls. Normal aging is associated with significant striatal dopaminergic denervation, which might be a previously unrecognized additional contributor to geriatric falls. This study investigated the relationship between the severity of age-associated striatal dopaminergic denervation (AASDD) and falls in community-dwelling subjects. Community-dwelling subjects who did not have a clinical diagnosis to explain falls (n = 77: 43 female, 34 male; mean age 61.4 +/- 16.4; range 20-85) completed clinical assessment and brain dopamine transporter (DAT) [11C]beta-CFT (2-beta-carbomethoxy-3beta-(4-fluorophenyl) tropane) positron emission tomography imaging followed by 6 months of prospective fall monitoring using diaries. Results showed a significant inverse relationship between striatal DAT activity and age (r = -0.82, p < 0.001). A total of 26 subjects (33.8%) reported at least one fall, with 5 subjects (6.5%) reporting two or more falls. While no significant difference was noted in striatal DAT activity between nonfallers (n = 51) and fallers (n = 26; f = 0.02, not significant), striatal DAT activity was modestly reduced in the small subgroup of recurrent fallers compared with the other subjects (f = 5.07, p < 0.05). Findings indicate that AASDD does not explain isolated self-reported falls in community-dwelling subjects. However, it may be a contributing factor in the small subgroup of subjects with recurrent falls.

Key words: AASDD, age-associated striatal dopaminergic denervation, aging, basal ganglia, dopamine transporter, fall diary, falls, nigrostriatal, Parkinson, positron emission tomography, recurrent falls.

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