• Michal Kafri, Efrat Sasson, Yaniv Assaf, Yaacov Balash, Orna Aiznstein, Jeffrey M Hausdorff, and Nir Giladi.
• Functional Brain Center, Wohl Institute for Advanced Imaging, Sourasky Medical Center, Tel Aviv, Israel.
• J Neuroimaging. 2013 Jan 1;23(1):39-46.

Background And PurposeHigh-level gait disorder (HLGD) is a debilitating disorder causing mobility decline in the elderly. Although its clinical characteristics are well described, its anatomical and pathophysiological underpinnings are poorly understood. This study examined the anatomical distribution of white matter (WM) changes in patients with mild to moderate HLGD of the cautious/disequilibrium type, using advanced magnetic resonance imaging (MRI) methods.MethodsThirteen patients with HLGD, 9 elderly and 13 middle-aged healthy controls were scanned using diffusion tensor imaging, Q-space imaging, and conventional MRI. The regions of significant differences between the HLGD group and the elderly control group were defined, and the mean fractional anisotropy and displacement values of these areas were extracted.ResultsThe HLGD patients had lower fractional anisotropy and higher displacement values in regions related to the motor system, including those along the corticospinal tract and the superior cerebellar peduncles, as well as in cognitive and affective-related areas, including the anterior limbs of the internal capsule and the genu of the corpus callosum.ConclusionsThe anatomical distribution associated with HLGD of the cautious/disequilibrium type involves WM pathways that convey motor-related, cognitive and affective-related functions. The underlying pathological process leading to these changes most probably includes demyelination.Copyright © 2012 by the American Society of Neuroimaging.

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