Enlarged Perivascular Spaces in the Basal Ganglia Independently Related to Gait Disturbances in Older People With Cerebral Small Vessel Diseases

Abstract

Background and ObjectiveGait disturbances are common in older people and are associated with adverse consequences, e.g., falls and institutionalization. Enlarged perivascular spaces in the basal ganglia (BG-EPVS) are considered an magnetic resonance imaging (MRI) marker of cerebral small vessel diseases (CSVD). However, the consequences of BG-EPVS are largely unknown. Previous studies showed that other CSVD markers were related to gait disturbances. However, the relation between BG-EPVS and gait performance is unclear. Therefore, we aimed to explore the relation between BG-EPVS and gait performance in elderly individuals.MethodsWe recruited older people with CSVD in the Neurology Department of our hospital from December 1, 2020 to October 31, 2021. Participants with BG-EPVS > 20 on the unilateral side of the basal ganglia slice containing the maximum number were classified into the BG-EPVS group (n = 78), and the rest were classified into the control group (n = 164). Quantitative gait parameters and gait variability were provided by the Intelligent Device for Energy Expenditure and Activity (IDEEA; MiniSun, United States) gait analysis system. Semiquantitative gait assessment was measured with the Tinetti test. Point-biserial correlation and multivariate linear regression analysis were performed to investigate the association between BG-EPVS and gait performance.ResultsThe BG-EPVS group had a slower gait speed and cadence, shorter stride length, longer stance phase percentage, smaller pre-swing angle and footfall, and lower Tinetti gait test and balance test scores compared with those in the control group (P < 0.05). There were no statistical differences in stride length variability and stride time variability between the two groups (P > 0.05). A correlation analysis showed that BG-EPVS were negatively related to gait speed, cadence, stride length, pre-swing angle, and footfall (γrange = −0.497 to −0.237, P < 0.001) and positively related to stance phase percentage (γ = 0.269, P < 0.001). BG-EPVS was negatively related to the score of the Tinetti gait test (γ = −0.449, P < 0.001) and the balance test (γ = −0.489, P < 0.001). The multiple linear regression analysis indicated that BG-EPVS was an independent risk factor for gait disturbances and poor balance after adjusting for confounders, including other CSVD markers.ConclusionLarge numbers of BG-EPVS were independently related to gait disturbances in older people with CSVD. This finding provides information about the consequences of BG-EPVS and risk factors for gait disturbances.

Assessing Glymphatic System Impairment in Alzheimer's Disease Using Enlarged Perivascular Spaces with Automatic Quantification and DTI-ALPS Method

“…Typically, EPVS is associated with cognitive decline in different neurodegenerative diseases [33] . These lesions share the same signal as CSF and appear linear on planes parallel to the course of blood vessels with diameters < 3 mm [34] . Abnormal dilated PVSs are associated with glymphatic dysfunction.…”

Longitudinal Assessment of Glymphatic Changes Following Mild Traumatic Brain Injury: Insights from PVS burden and DTI-ALPS Imaging

“…However, the basal ganglia ePVS burden significantly increased from acute to chronic stages, although no other associations with symptoms were found, either cross-sectionally or longitudinally. The basal ganglia region is commonly associated with ePVS 75 , and increased basal ganglia ePVS has been linked to cerebral small vessel diseases in gait disturbance 76 , and cognitive decline in early-stage Parkinson's Disease 77 . This suggests vulnerability to vascular and glymphatic changes in this region.…”

“…Reports of ALPS changes post-TBI primarily stem from retrospective studies, mostly showing reduced ALPS index in TBI patients compared to controls [50][51][52] . Lower ALPS index correlates with subarachnoid hemorrhage 50 , verbal memory, attention and executive functions 50,76 , and high blood levels of neurofilament light (NfL) chain 51 , a typical TBI marker. However, Dai et al observed increased ALPS in a group of 161 mTBI patients at an acute post-injury time (average of 5.6 days, mostly within 14 days) 78 , suggesting dynamic glymphatic activity changes post-TBI.…”

Effect of Upper Limb Motor Rehabilitation on Cognition in Parkinson’s Disease: An Observational Study

“…The abovementioned studies focused on gait and balance treatment, whereas we trained the upper limbs exclusively. In contrast to gait [ 50 , 51 , 52 ], during upper limb movements, prevalent cerebral activation occurs in the cortical areas (i.e., sensorimotor cortex, supplementary motor area, premotor cortex, inferior frontal gyrus and ipsilateral anterior cingulate) both in neurological patients and healthy controls [ 53 , 54 ]. Motor exercise may increase the production of growth factors and promote gray and white matter changes, especially in the prefrontal region, with a particular effect on executive functions [ 55 , 56 , 57 ].…”