Minor gait impairment despite white matter damage in pure small vessel disease
Minor gait impairment despite white matter damage in pure small vessel disease
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DOI：
10.1002/acn3.50891
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发表时间：
2019-10-01
影响因子：
5.3
通讯作者：
Duering, Marco
中科院分区：
文献类型：
--
作者：
Finsterwalder, Sofia;Wuehr, Max;Duering, Marco
目的：脑小血管病（SVD）患者常见步态障碍。然而，老年SVD患者的步态研究可能受到年龄相关合并症（如多发性神经病或肌肉减少症）的混淆。因此，我们研究了患有遗传学定义的SVD CADASIL的年轻患者。我们的目的是研究单纯SVD对单任务和双任务步态的影响，并研究步态表现与认知缺陷和白色物质改变的相关性。研究方法：我们调查了39名CADASIL患者（平均年龄50 +/- 8）使用计算机化走道的单任务行走和计算，语义或运动双重任务成本。我们获得了3.0T MRI和神经心理学数据的处理速度，在CADASIL的主要认知缺陷。时空步态参数标准化的基础上，从192名健康对照的数据。通过扩散张量成像评估的白色物质完整性与步态之间的关联使用全局标记和体素分析进行分析。结果：与对照组相比，CADASIL患者仅表现出轻度的单任务步态障碍，且仅在节律域。语义双重任务还发现轻度赤字的步伐域。处理速度与步态无关。白色物质的变化与单任务步幅有关，但与双任务绩效无关。释义：尽管有严重的疾病负担，但单纯小血管疾病患者的步态表现在单任务和双任务中相对保留。结果表明，除小血管疾病外的年龄相关病理可能对老年SVD患者的步态障碍起作用。
Objective: Gait impairment is common in patients with cerebral small vessel disease (SVD). However, gait studies in elderly SVD patients might be confounded by age-related comorbidities, such as polyneuropathy or sarcopenia. We therefore studied young patients with the genetically defined SVD CADASIL. Our aim was to examine the effects of pure SVD on single and dual task gait, and to investigate associations of gait performance with cognitive deficits and white matter alterations. Methods: We investigated single task walking and calculatory, semantic, or motoric dual task costs in 39 CADASIL patients (mean age 50 +/- 8) using a computerized walkway. We obtained 3.0T MRI and neuropsychological data on processing speed, the main cognitive deficit in CADASIL. Spatiotemporal gait parameters were standardized based on data from 192 healthy controls. Associations between white matter integrity, assessed by diffusion tensor imaging, and gait were analyzed using both a global marker and voxel-wise analysis. Results: Compared to controls, CADASIL patients showed only mild single task gait impairment, and only in the rhythm domain. The semantic dual task additionally uncovered mild deficits in the pace domain. Processing speed was not associated with gait. White matter alterations were related to single task stride length but not to dual task performance. Interpretation: Despite severe disease burden, gait performance in patients with pure small vessel disease was relatively preserved in single and dual tasks. Results suggest that age-related pathologies other than small vessel disease might play a role for gait impairment in elderly SVD patients.