Cerebral small vessel disease, cardiovascular risk factors, and future walking speed in old age: a population-based cohort study

Abstract

Background The purpose of this study was to examine the associations between combined and individual cerebral small vessel disease (cSVD) markers on future walking speed over 9 years; and to explore whether these associations varied by the presence of cardiovascular risk factors (CRFs). Methods This population-based cohort study included 331 adults, aged ≥60 years, without limitation in walking speed (≥0.8 m/s). At baseline, cSVD markers, including white matter hyperintensities (WMH), lacunes, and perivascular spaces (PVS), were assessed on magnetic resonance imaging. The modifiable CRFs (physical inactivity, heavy alcohol consumption, smoking, hypertension, high total cholesterol, diabetes, and overweight/obese) were combined into a score. The association between baseline cSVD markers and the decline in walking speed was examined using linear mixed-effects models, whereas Cox proportional hazards models were used to estimate the association with walking speed limitation (defined as < 0.8 m/s) over the follow-up. Results Over the follow-up period, 76 (23.0%) persons developed walking speed limitation. Participants in the highest tertile of the combined cSVD marker score had a hazard ratio (HR) of 3.78 (95% confidence interval [CI] 1.70-8.45) for walking speed limitation compared with people in the lowest score tertile, even after adjusting for socio-demographics, CRFs, cognitive function, and chronic conditions. When investigating the cSVD markers individually, having the highest burden of WMH was associated with a significantly faster decline in walking speed (β coefficient − 0.020; 95% CI -0.035-0.004) and a greater HR of walking speed limitation (HR 2.78; 95% CI 1.31-5.89) compared with having the lowest WMH burden. Similar results were obtained for the highest tertile of PVS (HR 2.13; 95% CI 1.04-4.36). Lacunes were associated with walking speed limitation, but only in men. Having ≥4 CRFs and high WMH volume simultaneously, showed a greater risk of walking speed limitation compared with having ≥4 CRFs and low WMH burden. CRFs did not modify the associations between lacunes or PVS and walking speed. Conclusions Combined cSVD markers strongly predict walking speed limitation in healthy older adults, independent of cognitive function, with WMH and PVS being the strongest contributors. Improving cardiovascular health may help to mitigate the negative effects of WMH on future walking speed.

White matter hyperintensities volume and cognition: A meta-analysis

“…The types of brain markers associated with CSVD include WMH, LI, EPVS, CMB, and brain atrophy (Heiland et al, 2021 ). CSVD is common in older adults (Kim et al, 2018 ) and is an important cause of cognitive and motor impairments (Willey et al, 2013 ).…”

The associations between Enlarged Perivascular Spaces and partial Clinical symptoms: a meta-analysis

“…Our results show that EPVS is associated with dyskinesia, unfortunately, we did not perform a subgroup analysis due to the small number of eligible related studies. A prospective study with a 9year follow-up showed that the highest tertile of EPVS increased the risk of dyskinesia by 2.13 times P r e p r i n t (HR 2.13; CI 1.04 -4.36), suggesting that dyskinesia may be related to the size and duration of EPVS [9] . However, the study by Daniela Pinter [55] showed that WMH was a significant predictor of gait and balance impairment, whereas EPVS was not significantly associated with movement impairment.…”

“…For cognitive impairment, 12 studies (n=9205) met our inclusion criteria [12,21,22,[26][27][28][29][30][31][32][33][34] . For movement disorders, 5 studies (n=1010) met our inclusion criteria [9,12,[35][36][37] . For sleep disturbances, 8 studies (n=1846) met our inclusion criteria [11,12,20,[38][39][40][41][42] .…”

“…Wan et al [36] , Oscar et al [37] , 2019 cross-sectional / risk of falls 3.36 (1.85-6.09) BG Atahualpa Emerald et al [9] , 2021 prospective 9 years Walking speed limitation 2.13 (1.04-4.36) / Sweden Melinda et al [12] , 2014 retrospective / Any movement disorder 1.47 (0.43-5.04) SCS Minnesota…”

“…In recent years, research on EPVS and clinical symptoms has gradually increased, such as cognitive impairment, movement disorders, depressive symptoms, sleep disorders, and stroke [8][9][10][11][12][13] , which bring huge social and economic burdens [14] . EPVS is closely related to age and the aging of society is a growing problem [15] , so understanding what it means to see many EPVS on MRI has important clinical implications.…”