Gait disorders of unknown cause in the elderly: Clinical and MRI findings

Franch, Oriol; Calandre, L; Álvarez‐Linera, Juan; Louis, Elan D.; Bermejo‐Pareja, Félix; Benito‐León, Julián

doi:10.1016/j.jns.2009.02.001

Cited by 19 publications

(10 citation statements)

References 33 publications

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“…In this study, we used DTI and QSI methods to investigate the anatomical distribution of WM changes in patients with HLGD. In addition to supporting previous studies demonstrating an association between WM changes and HLGD, 7,9,11,13,14 the MRI methods applied here were able to detect the involvement of specific WM pathways that have not been previously reported. Our findings suggest the involvement of specific motor‐related pathways, including the corticospinal tract (ie, the PLIC and the CP) and the SCP, in this disorder.…”

Section: Discussionsupporting

confidence: 86%

“…Several groups have used conventional magnetic resonance imaging (MRI) to search for brain abnormalities in patients with HLGD. [7][8][9][10][11][12][13][14] The findings of these studies suggest that white matter (WM) changes may be an im-portant cause of this gait impairment. The most common radiological parameter associated with HLGD using conventional MRI is the severity of WM hyperintensity (WMH), which is usually found to be most pronounced in the periventricular zone.…”

Section: Introductionmentioning

confidence: 99%

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High‐Level Gait Disorder: Associations with Specific White Matter Changes Observed on Advanced Diffusion Imaging

Kafri

Sasson

Assaf

et al. 2012

Journal of Neuroimaging

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Background and Purpose High-level gait disorder (HLGD) is a debilitating disorder causing mobility decline in the elderly. Although its clinical characteristics are well described, its anatomical and pathophysiological underpinnings are poorly understood. This study examined the anatomical distribution of white matter (WM) changes in patients with mild to moderate HLGD of the cautious/disequilibrium type, using advanced magnetic resonance imaging (MRI) methods. Methods Thirteen patients with HLGD, 9 elderly and 13 middle-aged healthy controls, were scanned using diffusion tensor imaging, Q-space imaging, and conventional MRI. The regions of significant differences between the HLGD group and the elderly control group were defined, and the mean fractional anisotropy and displacement values of these areas were extracted. Results The HLGD patients had lower fractional anisotropy and higher displacement values in regions related to the motor system, including those along the corticospinal tract and the superior cerebellar peduncles, as well as in cognitive and affective-related areas, including the anterior limbs of the internal capsule and the genu of the corpus callosum. Conclusions The anatomical distribution associated with HLGD of the cautious/disequilibrium type involves WM pathways that convey motor-related, cognitive and affective-related functions. The underlying pathological process leading to these changes most probably includes demyelination.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

High‐Level Gait Disorder: Associations with Specific White Matter Changes Observed on Advanced Diffusion Imaging

Kafri

Sasson

Assaf

et al. 2012

Journal of Neuroimaging

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“…The syndrome has frequently been suspected to be secondary to microvascular, subcortical, periventricular lesions and the term frontal subcortical clinical syndrome (FSCS) has been used by others to describe a similar clinical picture [27]. Patients with periventricular microvasculopathy primarily affecting the white matter may present with lower body parkinsonism and predominantly gait and posture disturbances that can mimic HLGD and is definitely in the differential diagnosis [29].…”

Section: Pathology Associated With Hlgdmentioning

confidence: 99%

Progressive nature of a higher level gait disorder: a 3-year prospective study

et al. 2010

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The objective of the study was to characterize the natural history of patients with a higher level gait disorder (HLGD) of the cautious/disequilibrium type in a 3-year prospective study. Subjects were taken from an outpatient setting in a movement disorders clinic. Twenty-two mobile, community-living patients with a HLGD of the cautious/disequilibrium type and 26 age- and gender-matched healthy controls were evaluated at baseline and approximately 3 years later. Detailed medical history, a complete, structured geriatric and neurological examination, mental and affective state, gait and balance assessment were obtained. At follow-up, marked declines were observed in gait, mobility and functional independence in the patients, but not in the controls. For example, 23% of the patients could not complete the Timed Up and Go test, compared to only 4% of the control group, and among those who could complete the test, time to completion was almost three times longer (P < 0.0001) in the patients (23 s), compared to the controls (8 s). At follow-up, 50% of the patients required a personal live-in caregiver compared to only 4% of the controls (P < 0.0001). Although mild extra-pyramidal, pyramidal, cognitive and affective alterations were observed at baseline in the patients, those symptoms were stable over time. Unexpectedly, there was no association between the presence of HLGD or its progression and vascular risk factors. HLGD is a debilitating, rapidly progressive disease. The profound deterioration in functional independence in a relatively short period of time suggests that early multidisciplinary interventions may be the appropriate clinical approach to the treatment of these patients who are at risk for a rapid decline in functional abilities.

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“…Classical vascular risk factors, such as hypertension, diabetes, and heart disease, have been associated with increased WMH burden (i.e., volume or severity) among community-dwelling and clinic-based older adults (DeCarli et al, 1999; Liao et al, 1997; Liao et al, 1996). Further, WMH have been linked with myriad cognitive, neurological, and psychiatric conditions among older adults, including depression (Gunning-Dixon et al,; Herrmann et al, 2008), age-associated cognitive decline (Gunning-Dixon and Raz, 2000), Alzheimer’s disease and its antecedent conditions (Brickman et al, 2008a; Brickman et al, 2009a; Luchsinger et al, 2009), migraine (Paemeleire, 2009), and gait or mobility disturbance (Bhadelia et al, 2009; Franch et al, 2009; Iseki et al,; Louis et al, 2008). These observations not only highlight the distinct role that small vessel cerebrovascular disease may play in these conditions but also emphasize how neuroimaging can be used to identify important sources of behavioral variance in clinical and non-clinical populations.…”

Section: Introductionmentioning

confidence: 99%

Quantitative approaches for assessment of white matter hyperintensities in elderly populations

Brickman

Sneed

Provenzano

et al. 2011

Psychiatry Research: Neuroimaging

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White matter hyperintensities (WMH) are areas of increased signal on T2-weighted magnetic resonance imaging (MRI), including fluid attenuated inverse recovery sequences. Total and regional WMH burden (i.e., volume or severity) has been associated with myriad cognitive, neurological, and psychiatric conditions among older adults. In the current report, we illustrate two approaches to quantify periventricular, deep, and total WMH and examine their reliability and criterion validity among 28 elderly patients enrolled in a depression treatment trial. The first approach, an operator-driven quantitative approach, involves visual inspection of individual MRI scans and manual labeling using a three-step series of procedures. The second approach, a fully automated quantitative approach, uses a processing stream that involves image segmentation, voxel intensity thresholding, and seed growing to label WMH and calculate their volume automatically. There was good agreement in WMH quantification between the two approaches (Cronbach’s alpha values from 0.835 to 0.968). Further, severity of WMH was significantly associated with worse depression and increased age, and these associations did not differ significantly between the two quantification approaches. We provide evidence for good reliability and criterion validity for two approaches for WMH volume determination. The operator-driven approach may be better suited for smaller studies with highly trained raters, whereas the fully automated quantitative approach may be more appropriate for larger, high-throughput studies.

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Gait disorders of unknown cause in the elderly: Clinical and MRI findings

Cited by 19 publications

References 33 publications

High‐Level Gait Disorder: Associations with Specific White Matter Changes Observed on Advanced Diffusion Imaging

High‐Level Gait Disorder: Associations with Specific White Matter Changes Observed on Advanced Diffusion Imaging

Progressive nature of a higher level gait disorder: a 3-year prospective study

Quantitative approaches for assessment of white matter hyperintensities in elderly populations

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