Background: Previous imaging studies have suggested links between brain pathologies and factors that are associated
with falls such as gait, balance and daily function. Possible neuropathological correlates of older people’s falls
have been suggested based on brain imaging studies, but to date none have been examined in brain tissue. Methods: Falls
data collected from repeated surveys of a population-based cohort of individuals aged at least 75 years old at baseline
were related to neuropathological data collected from post-mortem examination of the study’s associated brain donor collection
(n=212). Results: Amongst people without dementia, most cerebrovascular neuropathological features examined,
particularly white matter pallor, microinfarcts and microscopic atherosclerosis, were increasingly common across the subgroups
categorised by no reports of falling, only one or at least two reports of falling. The overall burden of pathology was
greater in those with dementia, but only microinfarcts showed a similar increase with respect to reported falling status.
Conclusions: Subclinical pathologies sharing a common vascular origin are associated with increased falling amongst
people with no dementia, as are microinfarcts in those with dementia. Although further research is needed to address the
mechanisms of falls and their neuropathological correlates, the findings from the current study would suggest that if cerebrovascular
disease prevention reduces vascular neuropathology changes this may have direct benefits in reducing falls
amongst older people with or without dementia.
Keywords: Neuropathology, accidental falls, dementia, old age, cohort study, mobility impairments, demyelination, Brain atrophy
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