Are Gait Disturbances and White Matter Degeneration Early Indicators of Vascular Dementia?

Abstract

The objective of this study was to correlate clinical and brain imaging findings with walking inabilities in patients with possible vascular dementia. For 24 patients with suspected initial vascular dementia according to DSM-III-R, structured neurological, neuropsychological and neuroimaging (magnetic resonance tomography) examinations were evaluated alongside computerized gait analysis. All patients revealed an increased variability of gait lines of various degrees: mild (11%), moderate (32%) and severe (57%). Lateralization of gait patterns was present in 68% and bipedal instabilities of posture in 54%. These findings were significantly correlated with frontal periventricular white matter lesions (WMLs), which probably affect the thalamo-cortico-mediocapsular pathways. The association of gait abnormalities with WMLs of the frontocentral subcortical and periventricular territories in patients with possible vascular dementing illnesses may be used as an early indicator of the disease for follow-up and treatment trials. However, since the degree of gait impairment varies considerably relative to the common mild intellectual limitations, these structural lesions are unlikely to be directly related to the dementing process.

Elevated Levels of Fragmented DNA Nucleosomes in Native and Activated Lymphocytes Indicate an Enhanced Sensitivity to Apoptosis in Sporadic Alzheimer’s Disease

“…Blood cells from 21 patients (12 men and 9 women) with subcortical vascular encephalopathy (SVE) [13,[18][19][20] following the diagnostic criteria for research studies (NINDS-AIREN) [21] were used as a second group of demented patients, to elucidate differences in pathogenesis. Patients underwent a structured medical and neurological examination as well as neuropsychological interviews following a research protocol with particular emphasis on the presence of motor and gait disturbances, urinary incontinence, memory and attention disorders, frontal release signs, and aspontaneous episodes.…”

“…Therefore, we included in our present study a well-characterized group of patients with subcortical vascular encephalopathy (SVE) [13]. Very interestingly, specific differences in intracellular calcium signalling have been already reported between AD and SVE [14].…”

Adhesion Molecules in Cerebrovascular Diseases

“…14 However, expression and release of adhesion molecules have not been investigated in different cerebrovascular diseases, ie, in patients with intracranial stenoses or in patients with subcortical vascular encephalopathy (SVE), a small-vessel disease characterized clinically by progressive dementia, emotional lability, gait disorders, and incontinence and neuroradiologically by subcortical diffuse periventricular white matter lesion and lacunes. [15][16][17] It is unclear why many patients have large-vessel disease without apparent cerebral microangiopathy, whereas others suffer selectively of cerebral microangiopathy. To obtain further information about differences and similarities regarding possible inflammatory endothelial activation, which is currently thought to play a role in atherogenesis, soluble adhesion molecules that are derived from activated endothelium were analyzed in cerebral macroangiopathy and microangiopathy.…”

Delays in auditory-cued step initiation are related to increased volume of white matter hyperintensities in older adults

“…Early descriptive studies reported gait difficulties, including wide base of support, short step length, increased step variability and turning "en bloc", in subjects with subcortical white matter lesions. (Thompson and Marsden 1987;Hennerici et al 1994;Baloh et al 1995;Briley et al 1997;Camicioli et al 1999;Ebersbach et al 1999). In addition, casecontrol studies demonstrated that the severity of white matter damage was associated with greater falls risk.…”

“…There is considerable evidence that damage to white matter tracts between the motor areas in the cortex, basal ganglia, thalamus and cerebellum interfere with the motor output to the lower extremities during balance tasks. (Hennerici et al 1994;Tell et al 1998;Guttmann et al 2000;Wolfson 2001;Onen et al 2004) The current preliminary study seeks to augment the information gained from previous work by explicitly testing the hypothesis that the degeneration of frontal-subcortical white matter pathways that are involved in motor function are related to deficits in postural performance that are served by these pathways. Consequently, in this study we used a sensory-cued choice reaction time (CRT) step task as a model for examining whether lesions in the white matter are associated with specific balance impairments (e.g.…”