Subclinical Brain Magnetic Resonance Imaging Abnormalities Predict Physical Functional Decline in High‐Functioning Older Adults

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Abstract
Objectives: To determine whether severity of subclinical brain magnetic resonance imaging (MRI) abnormalities predicts incident self‐reported physical impairment or rate of decline in motor performance.Design: Longitudinal analysis, average follow‐up time: 4.0 years.Setting: Cardiovascular Health Study (CHS).Participants: CHS participants with modified Mini‐Mental State Examination (3MS) score of 80 or greater, no self‐reported disability, no history of stroke, and at least one assessment of mobility (n=2,450, mean age=74.4).Measurements: Brain MRI abnormalities (ventricular enlargement, white matter hyperintensities, subcortical and basal ganglia small brain infarcts), self‐reported physical impairment (difficulty walking half a mile or with one or more activities of daily living), and motor performance (gait speed, timed chair stand).Results: After adjusting for demographics, cardiovascular risk factors, and diseases, risk of incident self‐reported physical impairment was 35% greater for those with severe ventricular enlargement than for those with minimal ventricular enlargement, 22% greater for those with moderate white matter hyperintensities than for those with minimal white matter hyperintensities, and 26% greater for participants with at least one brain infarct than for those with no infarcts. Those with moderate to severe brain abnormalities experienced faster gait speed decline (0.02 m/s per year) than those with no MRI abnormalities (0.01 m/s per year). Further adjustment for incident stroke, incident dementia, and 3MS score did not substantially attenuate hazard ratios for incident self‐reported physical impairment or coefficients for decline in gait speed.Conclusion: Subclinical structural brain abnormalities in high‐functioning older adults can increase the risk of developing physical disabilities and declining in motor performance.