To investigate cerebellar lobule atrophy patterns in elderly fallers (EFs) and their association with gait and cognitive performance.

Cognitive impairments, gait, and balance deficits are major risk factors for falls in older adults, however, their neural fingerprints remain poorly understood. Recent neuroimaging evidence highlight the role of the cerebellum in both sensorimotor, and cognitive brain networks, suggesting that it may play a role in fall risk.

N=14 EF (mean age ± SD = 78 ± 1.5 yrs; > 2 falls in the past 6 months), and 20 healthy controls (HCs) (mean age ± SD = 69.6 ± 1.3 yrs) underwent a 3 T MRI scan obtaining 3D T1-weighted images, cognitive, and gait assessments. Cerebellar lobules segmentation was performed using the CERES pipeline, and were adjusted for intra-cranial volume. The relationship between the segmented volumes, gait, and cognitive performance scores was assessed using hierarchical multiple linear regression adjusting for age and gender. 

EFs exhibited lower, yet not significant, cerebellar volumes in lobule VI, Crus II, lobule VIIB, and lobule X compared to HCs. No significant differences were detected between both groups in gait speed, and stride length during both usual-and-dual task walking (p>0.05). Compared to HCs, EFs showed lower MOCA scores (p=0.004), and Color Trails Making Test part b (TMTb) scores (p=0.028). In this group, regression analysis showed that cerebellar metrics accounted for extra variance in both motor and cognitive performance, where lobule VI, VIIB, X, and Crus II volumes being independent predictors for normal walking stride length, dual-task gait speed, TMTb, and TMTb respectively (p < 0.05). No significant associations between cerebellar lobule volumes, and performance scores were observed in HCs.

The observed patterns of cerebellar lobule atrophy and their associations with motor and cognitive performance might allude to cerebellar involvement in the pathophysiology of falls in older adults.