Cerebral Small Vessel Disease and Gait Speed in Older Adults without Dementia

Abstract

AbstractBackgroundDisturbances in gait have been found to be predictors of dementia and mobility disability in older adults. The relationship between cerebral small vessel disease (CSVD) and gait speed during simple (normal pace walking; NPW) and complex walking (walking‐while talking; WWT) conditions are not well understood. The current study examined the relationship between CSVD (as assessed as white matter hyperintensities and lacunes), NPW and WWT in older adults without dementia.MethodsNPW and WWT speeds were measured in 113 older adults (46.9% female, 53.1%% male, mean age=78.6±6.3) without dementia enrolled in the LonGenity study. Using an established rating system, white matter hyperintensities (WMH) and lacunes of presumed vascular origin were quantified from Fluid Attenuated Inversion Recovery (FLAIR) images from the same participants. Linear regression models adjusted for age, gender, global health, cohort, and estimated total intracranial volume were used to examine the association between NPW and DTW velocity and markers of CSVD.ResultsNumber of WMH in both the basal ganglia and the temporal lobes were associated with slower NPW velocity in our adjusted models (β=‐3.274 cm/s p=.047, β=‐3.113 cm/s p=.048, respectively). Number of frontal lobe WMH was associated with slower NPW velocity in our unadjusted model (β=‐3.316 cm/s p=.017) but not in the adjusted model (β=‐1.521 cm/s p=.262). WMH were not found to be significantly associated with WWT velocity. Lacunes of presumed vascular origin were not found to be significantly associated with neither NPW or DTW velocity. Significant interactions between measures of CSVD and gender, age, or cohort were not found in our models.ConclusionGait is a complex task requiring the integration of both cognitive and motor function across different brain regions. We find here that higher CSVD burden as measured by the presence of WMH in the basal ganglia and temporal lobes are independently associated with slower normal gait velocity. Interestingly, no such association was seen with WWT, a task requiring a higher cognitive load. Further studies are needed to establish temporality of these lesions with declines in gait velocity. Doing so may show utility of CSVD imaging markers as predictors of gait disturbances and dementia.