Minor gait impairment despite white matter damage in pure small vessel disease.

Sofia Finsterwalder,Marco Duering,Benno Gesierich,Max Wuehr,Marek J Konieczny,Reinhold Schmidt,Roman Schniepp,Anna Dietze

doi:10.1002/acn3.50891

Abstract

ObjectiveGait impairment is common in patients with cerebral small vessel disease (SVD). However, gait studies in elderly SVD patients might be confounded by age‐related comorbidities, such as polyneuropathy or sarcopenia. We therefore studied young patients with the genetically defined SVD CADASIL. Our aim was to examine the effects of pure SVD on single and dual task gait, and to investigate associations of gait performance with cognitive deficits and white matter alterations.MethodsWe investigated single task walking and calculatory, semantic, or motoric dual task costs in 39 CADASIL patients (mean age 50 ± 8) using a computerized walkway. We obtained 3.0T MRI and neuropsychological data on processing speed, the main cognitive deficit in CADASIL. Spatiotemporal gait parameters were standardized based on data from 192 healthy controls. Associations between white matter integrity, assessed by diffusion tensor imaging, and gait were analyzed using both a global marker and voxel‐wise analysis.ResultsCompared to controls, CADASIL patients showed only mild single task gait impairment, and only in the rhythm domain. The semantic dual task additionally uncovered mild deficits in the pace domain. Processing speed was not associated with gait. White matter alterations were related to single task stride length but not to dual task performance.InterpretationDespite severe disease burden, gait performance in patients with pure small vessel disease was relatively preserved in single and dual tasks. Results suggest that age‐related pathologies other than small vessel disease might play a role for gait impairment in elderly SVD patients.

Highlights

Gait impairment and cognitive deficits are common symptoms in cerebral small vessel disease (SVD) and a major cause of loss of independence.[1,2] For mobility capabilities, both symptoms bear a high risk for falls and fractures, in the elderly.[3]
Results suggest that age-related pathologies other than small vessel disease might play a role for gait impairment in elderly SVD patients
Global white matter alterations are associated with single task stride length we examined the impact of SVD-related white matter alterations on gait performance

Summary

Introduction

Gait impairment and cognitive deficits are common symptoms in cerebral small vessel disease (SVD) and a major cause of loss of independence.[1,2] For mobility capabilities, both symptoms bear a high risk for falls and fractures, in the elderly.[3]. The notion is based on experiments using cognitive dual-tasking, in which participants perform an attention-demanding task while walking.[12]

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Discussion

Conclusion