Gait variability predicts cognitive impairment in older adults with subclinical cerebral small vessel disease

Abstract

IntroductionAdvanced methods of gait research, including approaches to quantify variability, and orderliness/regularity/predictability, are increasingly used to identify patients at risk for the development of cognitive impairment. Cerebral small vessel disease (CSVD) is highly prevalent in older adults and is known to contribute to the development of vascular cognitive impairment and dementia (VCID). Studies in preclinical models demonstrate that subclinical alterations precede CSVD-related cognitive impairment in gait coordination. In humans, CSVD also associates with gait abnormalities. The present study was designed to test the hypothesis that increased gait variability and gait asymmetry predict a decline in cognitive performance in older adults with CSVD.MethodsTo test this hypothesis, we compared cognitive performance and gait function in patients with CSVD (age: 69.8 ± 5.3 years; n = 11) and age- and sex-matched control participants (age: 70.7 ± 5.8 years; n = 11). Based on imaging findings, patients with CSVD were identified [presence of white matter hyperintensities plus silent brain infarcts and/or microhemorrhages on magnetic resonance imaging (MRI) assessment]. Cognitive performance was assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB). Gait parameters were measured during the single and dual tasks, during which participants, in addition to the motor task, completed a series of mental arithmetic calculations. Spatial and temporal parameters of gait variability, symmetry, and permutation entropy were determined using a pressure-sensitive gait mat during single and dual cognitive task conditions.ResultsPatients with CSVD exhibited lower performance in a visual learning test (p = 0.030) and in a sustained attention test (p = 0.007). CSVD also affected step time variability (p = 0.009) and step length variability (p = 0.017). Step lengths of CSVD participants were more asymmetric (p = 0.043) than that of controls, while the two groups were statistically similar regarding step time symmetry and entropy of step time and length. Gait variability was inversely associated with sustained attention, especially among CSVD patients, and this relationship was significantly different between the two groups. The association of sustained attention with gait symmetry was also significantly different between the two groups.DiscussionOur findings provide additional evidence in support of the concept that increased gait variability and asymmetry may predict cognitive impairment in older adults with CSVD.

Stride length and cerebellar regulation: Key features of early gait disorder in cerebral small vessel disease

“… 26 In another American study, there were also differences in stride length between patients with CSVD and controls. 27 Different from previous studies of CSVD, we did not find a significant difference in gait velocity between HCs and patients with CSVD. 28 , 29 , 30 Actually, in previous studies of gait in CSVD, seldom were subjects with dementia excluded, resulting in a potential influence on the results.…”

“…reported stride length was the most sensitive parameter related to white matter lesions 26 . In another American study, there were also differences in stride length between patients with CSVD and controls 27 . Different from previous studies of CSVD, we did not find a significant difference in gait velocity between HCs and patients with CSVD 28–30 .…”

Cerebral small vessel disease pathology in COVID-19 patients: A systematic review

“…The patient remained cognitively impaired at 10 months following acute infection , indicating a prolonged thromboinflammatory state, potentially leading to long-term dysregulation of cerebromicrovascular endothelial function, impairing executive function and processing speed. Additionally, multiple studies have shown persistent cognitive dysfunction in COVID-19 patients with CSVD pathology, ( Backman et al, 2022 , De Stefano et al, 2020 , Tristán-Samaniego et al, 2022 ), and impaired gait patient during acute infection ( Abdi et al, 2020 ), a marker of CSVD-associated cognitive decline ( Mukli et al, 2022 ). Cerebrospinal fluid (CSF) was tested for the presence of SARS-CoV-2 by RT-PCR in nine cases and all were negative for the virus ( Abdi et al, 2020 , De Stefano et al, 2020 , Haroon et al, 2020 , Liang et al, 2021 , Neppala et al, 2021 , Piazza et al, 2021 , Rajendran et al, 2021 , Tristán-Samaniego et al, 2022 , Zhang et al, 2021 ).…”

A wearable sensor and machine learning estimate step length in older adults and patients with neurological disorders

“…The trade-off between the SLE accuracy obtained by this method and the ability to estimate instantaneous step length was also explored. Assessing this trade-off is important for outcomes such as step-to-step variability that can provide additional diagnostic, prognostic, and mechanistic information 13 , 49 , 50 when instantaneous values of step length are available and step-to-step variability can be determined. In addition, we also aimed to better understand the results of the models in terms of the feature importance, error analysis, and the impact of gait speed, which can be used for future improvements.…”