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Vazquez JP, Verghese J, Barzilai N, Milman S, Blumen HM. White Matter Hyperintensities Are Associated with Slower Gait Speed in Older Adults without Dementia. NEURODEGENER DIS 2024:1-9. [PMID: 39025052 DOI: 10.1159/000538944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/08/2024] [Indexed: 07/20/2024] Open
Abstract
INTRODUCTION Slow gait speed is associated with poor health outcomes in aging, but the relationship between cerebral small vessel disease (CSVD) pathologies and gait speed in aging is not well understood. We investigated the relationships between CSVD imaging markers and gait speed during simple (normal pace walking [NPW]) and complex (walking while talking [WWT]) as both measures are associated with shared health outcomes such as falls, frailty, disability, mortality, and dementia. METHODS A total of 113 Ashkenazi Jewish adults over 65 (M age = 78.6 ± 6.3 years, 45.8% women) and without dementia were examined. Established rating systems were used to quantify white matter hyperintensities (WMHs) and lacunes of presumed vascular origin from fluid-attenuated inversion recovery (FLAIR) images. Linear regression models adjusted for age, sex, global health, and total intracranial volume were used to examine associations between CSVD markers and gait speed during NPW and WWT. Student t tests were used to contrast gait speed in those with "confluent-diffuse" WMH and those with "mild or no" WMH. RESULTS The number of WMH in the basal ganglia (β = -3.274 cm/s p = 0.047) and temporal lobes (β = -3.113 cm/s p = 0.048) were associated with slower NPW speed in adjusted models. Participants with higher CSVD burden (confluent-diffuse pattern) in the frontal lobe (94.65 cm/s vs. 105.21 cm/s, p = 0.018) and globally (98.98 cm/s vs. 107.24 cm/s, p = 0.028) also had lower NPW speed. WMHs were not associated with WWT speeds. Lacunes were not associated with NPW or WWT speed. CONCLUSION Adjusted models found higher CSVD burden as measured by the presence of WMH in the basal ganglia and temporal lobes were associated with slower normal pace gait speed in older adults, but not with complex walking speeds. Participants with confluent-diffuse WMHs in the frontal lobes were found to have slower average normal gait speed. Further studies are needed to establish the temporality of WMH and gait speed decline as well as mechanistic links between the two.
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Affiliation(s)
- Juan P Vazquez
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA,
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Genetics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sofiya Milman
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Helena M Blumen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
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Xu K, Wang Y, Jiang Y, Wang Y, Li P, Lu H, Suo C, Yuan Z, Yang Q, Dong Q, Jin L, Cui M, Chen X. Analysis of gait pattern related to high cerebral small vessel disease burden using quantitative gait data from wearable sensors. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 250:108162. [PMID: 38631129 DOI: 10.1016/j.cmpb.2024.108162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND AND OBJECTIVES Sensor-based wearable devices help to obtain a wide range of quantitative gait parameters, which provides sufficient data to investigate disease-specific gait patterns. Although cerebral small vessel disease (CSVD) plays a significant role in gait impairment, the specific gait pattern associated with a high burden of CSVD remains to be explored. METHODS We analyzed the gait pattern related to high CSVD burden from 720 participants (aged 55-65 years, 42.5 % male) free of neurological disease in the Taizhou Imaging Study. All participants underwent detailed quantitative gait assessments (obtained from an insole-like wearable gait tracking device) and brain magnetic resonance imaging examinations. Thirty-three gait parameters were summarized into five gait domains. Sparse sliced inverse regression was developed to extract the gait pattern related to high CSVD burden. RESULTS The specific gait pattern derived from several gait domains (i.e., angles, phases, variability, and spatio-temporal) was significantly associated with the CSVD burden (OR=1.250, 95 % CI: 1.011-1.546). The gait pattern indicates that people with a high CSVD burden were prone to have smaller gait angles, more stance time, more double support time, larger gait variability, and slower gait velocity. Furthermore, people with this gait pattern had a 25 % higher risk of a high CSVD burden. CONCLUSIONS We established a more stable and disease-specific quantitative gait pattern related to high CSVD burden, which is prone to facilitate the identification of individuals with high CSVD burden among the community residents or the general population.
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Affiliation(s)
- Kelin Xu
- Department of Biostatistics, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, China
| | - Yingzhe Wang
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China; Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanfeng Jiang
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China; Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Yawen Wang
- Department of Biostatistics, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, China
| | - Peixi Li
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Heyang Lu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chen Suo
- Fudan University Taizhou Institute of Health Sciences, Taizhou, China; Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, China
| | - Ziyu Yuan
- Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Qi Yang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Jin
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China; Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Mei Cui
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Xingdong Chen
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China; Fudan University Taizhou Institute of Health Sciences, Taizhou, China.
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Mo Y, Ji B, Ke Z, Mao C, Jiang J, Huang Y, Qin R, Huang L, Yang D, Hu Z, Xu Y. Stride length and cerebellar regulation: Key features of early gait disorder in cerebral small vessel disease. CNS Neurosci Ther 2024; 30:e14545. [PMID: 38421136 PMCID: PMC10850804 DOI: 10.1111/cns.14545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/10/2023] [Accepted: 11/18/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES Gait disorder (GD) is a common problem in cerebral small vessel disease (CSVD). This study aimed to determine (1) the early characteristics of GD in CSVD, (2) cerebellar neuroimaging features related to GD in CSVD, and (3) the association of cognitive impairment with GD. METHODS In total, 183 subjects were enrolled in this study: patients with CSVD with normal cognitive function (CSVD-NC) group (64 subjects), patients with CSVD with mild cognitive impairment (CSVD-MCI) group (66 subjects), and a healthy control (HC) group (53 subjects). The GD patterns were evaluated using the ReadyGo three-dimensional motion balance testing system. Meanwhile, we analyzed the cerebrum and cerebellum structurally and functionally. Correlation analyses were conducted among gait indicators, neuroimaging features, and neuropsychological tests. RESULTS Both the CSVD-NC and CSVD-MCI groups had a reduced stride length, cortical atrophy in the left cerebellum VIIIb, and decreased functional connectivity between the left cerebellum VIIIb and left SFGmed compared with the HC group. In the correlation analysis, the gray matter probability of the left cerebellum VIIIb was closely related to stride length in the HC group. In the CSVD-MCI group, linguistic function, memory, and attention were significantly correlated with gait performance. CONCLUSION Decreased stride length was the earliest characteristic of GD in CSVD. Structural and functional regulation of the left cerebellum VIIIb could play a particularly important role in early GD in CSVD.
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Affiliation(s)
- Yuting Mo
- Department of Neurology, Nanjing Drum Tower HospitalClinical College of Nanjing Medical UniversityNanjingChina
| | - Biying Ji
- Department of Neurology, Nanjing Drum Tower HospitalClinical College of Nanjing Medical UniversityNanjingChina
| | - Zhihong Ke
- Department of Neurology, Nanjing Drum Tower HospitalClinical College of Nanjing Medical UniversityNanjingChina
| | - Chenglu Mao
- Department of Neurology, Nanjing Drum Tower HospitalAffiliated Hospital of Medical School, Nanjing UniversityNanjingChina
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical DiseasesNanjing UniversityNanjingChina
| | - Jialiu Jiang
- Department of Neurology, Nanjing Drum Tower HospitalAffiliated Hospital of Medical School, Nanjing UniversityNanjingChina
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical DiseasesNanjing UniversityNanjingChina
| | - Yanan Huang
- Department of Neurology, Nanjing Drum Tower HospitalAffiliated Hospital of Medical School, Nanjing UniversityNanjingChina
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical DiseasesNanjing UniversityNanjingChina
| | - Ruomeng Qin
- Department of Neurology, Nanjing Drum Tower HospitalAffiliated Hospital of Medical School, Nanjing UniversityNanjingChina
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical DiseasesNanjing UniversityNanjingChina
| | - Lili Huang
- Department of Neurology, Nanjing Drum Tower HospitalAffiliated Hospital of Medical School, Nanjing UniversityNanjingChina
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical DiseasesNanjing UniversityNanjingChina
| | - Dan Yang
- Department of Neurology, Nanjing Drum Tower HospitalClinical College of Nanjing Medical UniversityNanjingChina
| | - Zheqi Hu
- Department of Neurology, Nanjing Drum Tower HospitalAffiliated Hospital of Medical School, Nanjing UniversityNanjingChina
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical DiseasesNanjing UniversityNanjingChina
| | - Yun Xu
- Department of Neurology, Nanjing Drum Tower HospitalClinical College of Nanjing Medical UniversityNanjingChina
- Department of Neurology, Nanjing Drum Tower HospitalAffiliated Hospital of Medical School, Nanjing UniversityNanjingChina
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical DiseasesNanjing UniversityNanjingChina
- Jiangsu Key Laboratory for Molecular MedicineMedical School of Nanjing UniversityNanjingChina
- Jiangsu Province Stroke Center for Diagnosis and TherapyNanjing Drum Tower HospitalNanjingChina
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Marcolini S, Mondragón JD, Bron EE, Biessels GJ, Claassen JA, Papma JM, Middelkoop H, Dierckx RA, Borra RJ, Ramakers IH, van der Flier WM, Maurits NM, De Deyn PP. Small vessel disease burden and functional brain connectivity in mild cognitive impairment. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 6:100192. [PMID: 38174052 PMCID: PMC10758699 DOI: 10.1016/j.cccb.2023.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
Background The role of small vessel disease in the development of dementia is not yet completely understood. Functional brain connectivity has been shown to differ between individuals with and without cerebral small vessel disease. However, a comprehensive measure of small vessel disease quantifying the overall damage on the brain is not consistently used and studies using such measure in mild cognitive impairment individuals are missing. Method Functional brain connectivity differences were analyzed between mild cognitive impairment individuals with absent or low (n = 34) and high (n = 34) small vessel disease burden using data from the Parelsnoer Institute, a Dutch multicenter study. Small vessel disease was characterized using an ordinal scale considering: lacunes, microbleeds, perivascular spaces in the basal ganglia, and white matter hyperintensities. Resting state functional MRI data using 3 Tesla scanners was analyzed with group-independent component analysis using the CONN toolbox. Results Functional connectivity between areas of the cerebellum and between the cerebellum and the thalamus and caudate nucleus was higher in the absent or low small vessel disease group compared to the high small vessel disease group. Conclusion These findings might suggest that functional connectivity of mild cognitive impairment individuals with low or absent small vessel disease burden is more intact than in mild cognitive impairment individuals with high small vessel disease. These brain areas are mainly responsible for motor, attentional and executive functions, domains which in previous studies were found to be mostly associated with small vessel disease markers. Our results support findings on the involvement of the cerebellum in cognitive functioning.
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Affiliation(s)
- Sofia Marcolini
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen 9713 GZ, the Netherlands
| | - Jaime D. Mondragón
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen 9713 GZ, the Netherlands
- Universidad Nacional Autónoma de México, Instituto de Neurobiología, Departamento de Neurobiología Conductual y Cognitiva, Laboratorio de Psicofisiología, Querétaro 76230, Mexico
- San Diego State University, Department of Psychology, Life-Span Human Senses Lab, San Diego, California 92182, USA
| | - Esther E. Bron
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam 3015 GD, the Netherlands
| | - Geert J. Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht 3584 CX, the Netherlands
| | - Jurgen A.H.R. Claassen
- Department of Geriatrics, Radboud University Medical Center and Donders Institute, Nijmegen 6525 GD, the Netherlands
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Janne M. Papma
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam 3015 GD, the Netherlands
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam 3015 GD, the Netherlands
| | - Huub Middelkoop
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden 2316 XC, the Netherlands
- Department of Neurology, Leiden University Medical Centre, Leiden 2333 ZA, the Netherlands
| | - Rudi A.J.O. Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, the Netherlands
| | - Ronald J.H. Borra
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, the Netherlands
| | - Inez H.G.B. Ramakers
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht 6229 ER, the Netherlands
| | - Wiesje M. van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam 1081 HZ, the Netherlands
- Department of Epidemiology & Data Sciences, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam 1117, the Netherlands
| | - Natasha M. Maurits
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen 9713 GZ, the Netherlands
| | - Peter P. De Deyn
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen 9713 GZ, the Netherlands
- Laboratory of Neurochemistry and Behavior, University of Antwerp, Antwerp 2610, Belgium
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Wang J, Wang X, Li H, Shi L, Song N, Xie J. Updates on brain regions and neuronal circuits of movement disorders in Parkinson's disease. Ageing Res Rev 2023; 92:102097. [PMID: 38511877 DOI: 10.1016/j.arr.2023.102097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 03/22/2024]
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disease with a global burden that affects more often in the elderly. The basal ganglia (BG) is believed to account for movement disorders in PD. More recently, new findings in the original regions in BG involved in motor control, as well as the new circuits or new nucleuses previously not specifically considered were explored. In the present review, we provide up-to-date information related to movement disorders and modulations in PD, especially from the perspectives of brain regions and neuronal circuits. Meanwhile, there are updates in deep brain stimulation (DBS) and other factors for the motor improvement in PD. Comprehensive understandings of brain regions and neuronal circuits involved in motor control could benefit the development of novel therapeutical strategies in PD.
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Affiliation(s)
- Juan Wang
- Institute of Brain Science and Disease, School of Basic Medicine, Qingdao University, Qingdao, Shandong, China; Shandong Provincial Collaborative Innovation Center for Neurodegenerative Disorders, Qingdao University, Qingdao, Shandong, China; Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, Qingdao University, Qingdao, Shandong, China
| | - Xiaoting Wang
- Institute of Brain Science and Disease, School of Basic Medicine, Qingdao University, Qingdao, Shandong, China; Shandong Provincial Collaborative Innovation Center for Neurodegenerative Disorders, Qingdao University, Qingdao, Shandong, China; Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, Qingdao University, Qingdao, Shandong, China
| | - Hui Li
- Institute of Brain Science and Disease, School of Basic Medicine, Qingdao University, Qingdao, Shandong, China; Shandong Provincial Collaborative Innovation Center for Neurodegenerative Disorders, Qingdao University, Qingdao, Shandong, China; Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, Qingdao University, Qingdao, Shandong, China
| | - Limin Shi
- Institute of Brain Science and Disease, School of Basic Medicine, Qingdao University, Qingdao, Shandong, China; Shandong Provincial Collaborative Innovation Center for Neurodegenerative Disorders, Qingdao University, Qingdao, Shandong, China; Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, Qingdao University, Qingdao, Shandong, China
| | - Ning Song
- Institute of Brain Science and Disease, School of Basic Medicine, Qingdao University, Qingdao, Shandong, China; Shandong Provincial Collaborative Innovation Center for Neurodegenerative Disorders, Qingdao University, Qingdao, Shandong, China; Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, Qingdao University, Qingdao, Shandong, China.
| | - Junxia Xie
- Institute of Brain Science and Disease, School of Basic Medicine, Qingdao University, Qingdao, Shandong, China; Shandong Provincial Collaborative Innovation Center for Neurodegenerative Disorders, Qingdao University, Qingdao, Shandong, China; Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, Qingdao University, Qingdao, Shandong, China.
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Chan LKM, Chan DKY. Cerebral small vessel disease (CSVD) with Romberg sign and falls. BMJ Case Rep 2023; 16:e256286. [PMID: 37541699 PMCID: PMC10407348 DOI: 10.1136/bcr-2023-256286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023] Open
Affiliation(s)
- Luke Kar Man Chan
- Department of Anaesthesia, Gold Coast University Hospital, Southport, Queensland, Australia
- Griffith University School of Medicine and Dentistry, Gold Coast, Queensland, Australia
| | - Daniel Kam Yin Chan
- University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Department of Aged Care and Rehabilitation, Bankstown Hospital, Bankstown, New South Wales, Australia
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Mao HJ, Zhang JX, Zhu WC, Zhang H, Fan XM, Han F, Ni J, Zhou LX, Yao M, Tian F, Su N, Zhu YC. Basal Ganglia and Brainstem Located Cerebral Microbleeds Contributed to Gait Impairment in Patients with Cerebral Small Vessel Disease. J Alzheimers Dis 2023:JAD230005. [PMID: 37355892 DOI: 10.3233/jad-230005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
BACKGROUND The mechanism of gait disorder in patients with cerebral small vessel disease (CSVD) remains unclear. Limited studies have compared the effect of cerebral microbleeds (CMBs) and lacunes on gait disturbance in CSVD patients in different anatomical locations. OBJECTIVE To investigate the relationship of quantitative gait parameters with varied anatomically located MRI imaging markers in patients with CSVD. METHODS Quantitative gait tests were performed on 127 symptomatic CSVD patients all with diffuse distributed white matter hyperintensities (WMHs). CMBs and lacunes in regard to anatomical locations and burdens were measured. The correlation between CSVD imaging markers and gait parameters was evaluated using general linear model analysis. RESULTS Presence of CMBs was significantly associated with stride length (β= -0.098, p = 0.0272) and right step length (β= -0.054, p = 0.0206). Presence of CMBs in basal ganglia (BG) was significantly associated with stride length and step length. Presence of CMBs in brainstem was significantly associated with gait parameters including stride length, step length, step height, and step width. Presence of lacunes in brainstem was significantly associated with gait speed (β= -0.197, p = 0.0365). However, presence of lacunes in the other areas was not associated with worse gait performances. CONCLUSION BG and brain stem located CMBs contributed to gait impairment in symptomatic CSVD patients.
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Affiliation(s)
- He-Jiao Mao
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jiang-Xia Zhang
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wen-Cheng Zhu
- State Key Laboratory of Computer Science, Institute of Software, Chinese Academy of Sciences, Beijing, China
| | - Hao Zhang
- State Key Laboratory of Computer Science, Institute of Software, Chinese Academy of Sciences, Beijing, China
| | - Xiang-Min Fan
- State Key Laboratory of Computer Science, Institute of Software, Chinese Academy of Sciences, Beijing, China
| | - Fei Han
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jun Ni
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Li-Xin Zhou
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ming Yao
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Feng Tian
- State Key Laboratory of Computer Science, Institute of Software, Chinese Academy of Sciences, Beijing, China
| | - Ning Su
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yi-Cheng Zhu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Wang Y, Li Y, Liu S, Liu P, Zhu Z, Wu J. Gait characteristics related to fall risk in patients with cerebral small vessel disease. Front Neurol 2023; 14:1166151. [PMID: 37346167 PMCID: PMC10279878 DOI: 10.3389/fneur.2023.1166151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023] Open
Abstract
Background Falls and gait disturbance are significant clinical manifestations of cerebral small vessel disease (CSVD). However, few relevant studies are reported at present. We aimed to investigate gait characteristics and fall risk in patients with CSVD. Methods A total of 119 patients with CSVD admitted to the Department of Neurology at Tianjin Huanhu Hospital between 17 August 2018 and 7 November 2018 were enrolled in this study. All patients underwent cerebral magnetic resonance imaging scanning and a 2-min walking test using an OPAL wearable sensor and Mobility Lab software. Relevant data were collected using the gait analyzer test system to further analyze the time-space and kinematic parameters of gait. All patients were followed up, and univariate and multivariate logistic regression analyses were conducted to analyze the gait characteristics and relevant risk factors in patients with CSVD at an increased risk of falling. Results All patients were grouped according to the presence or absence of falling and fear of falling and were divided into a high-fall risk group (n = 35) and a low-fall risk group (n = 72). Logistic multivariate regression analysis showed that the toe-off angle [odds ratio (OR) = 0.742, 95% confidence interval (CI) 0.584-0.942, p < 0.05], toe-off angle coefficient of variation (CV) (OR = 0.717, 95% CI: 0.535-0.962, p < 0.05), stride length CV (OR = 1.256, 95% CI: 1.017-1.552, p < 0.05), and terminal double support CV (OR = 1.735, 95% CI: 1.271-2.369, p < 0.05) were statistically significant (p < 0.05) and were independent risk factors for high-fall risk in patients with CSVD. Conclusion CSVD patients with seemingly normal gait and ambulation independently still have a high risk of falling, and gait spatiotemporal-kinematic parameters, gait symmetry, and gait variability are important indicators to assess the high-fall risk. The decrease in toe-off angle, in particular, and an increase in related parameters of CV, can increase the fall risk of CSVD patients.
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Affiliation(s)
- Yajing Wang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
| | - Yanna Li
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
| | - Shoufeng Liu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
| | - Peipei Liu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
| | - Zhizhong Zhu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, China
| | - Jialing Wu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China
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Mo Y, Mao C, Yang D, Ke Z, Huang L, Yang Z, Qin R, Huang Y, Lv W, Hu Z, Xu Y. Altered neuroimaging patterns of cerebellum and cognition underlying the gait and balance dysfunction in cerebral small vessel disease. Front Aging Neurosci 2023; 15:1117973. [PMID: 36967823 PMCID: PMC10032207 DOI: 10.3389/fnagi.2023.1117973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/13/2023] [Indexed: 03/05/2023] Open
Abstract
BackgroundThe mechanism of gait and balance dysfunction (GBD) in cerebral small vessel disease (CSVD) remains unclear. Evidence supports cognition engages in GBD of CSVD. The cerebellum is important in motor and cognition, while little is known about the influence of the cerebellum on GBD in CSVD.MethodsThis study is a retrospective cohort study. All participants of this study were enrolled from the CSVD individuals in Nanjing Drum Tower Hospital from 2017 to 2021. The GBD of CSVD patients was defined as Tinetti Test score ≤ 23. Cerebral cortical thickness, cerebellar gray matter volume, the amplitude of low-frequency fluctuation, functional connectivity, and modular interaction were calculated to determine the cortical atrophy and activity patterns of CSVD patients with GBD. The effect of cognitive domains during GBD in CSVD patients was explored by correlation analyses.ResultsA total of 25 CSVD patients were recruited in CSVD patients with GBD group (Tinetti Test score ≤ 23, mean age ± standard deviation: 70.000 ± 6.976 years), and 34 CSVD patients were recruited in CSVD patients without GBD group (Tinetti Test score > 23, mean age ± standard deviation: 64.029 ± 9.453 years). CSVD patients with GBD displayed worse cognitive performance and cortical atrophy in the right cerebellum VIIIa and bilateral superior temporal gyrus than those without GBD. The right postcentral gyrus, left inferior temporal gyrus, right angular gyrus, right supramarginal gyrus and right middle frontal gyrus were functionally overactivated and showed decreased modular interaction with the right cerebellum. Tinetti Test scores were negatively related to the volume of the right cerebellum VIIIa in CSVD patients with GBD. Notably, memory, especially visuospatial memory, was greatly associated with GBD in CSVD.ConclusionThe cortical atrophy and altered functional activity in sensorimotor area and ventral attention network in the cerebellum and cerebrum may underlying the GBD in CSVD. Memory might be critically cognitively responsible for GBD in CSVD.
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Affiliation(s)
- Yuting Mo
- Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Chenglu Mao
- Medical School, State Key Laboratory of Pharmaceutical Biotechnology, Department of Neurology, Drum Tower Hospital, Institute of Brain Science, Nanjing University, Nanjing, China
- Nanjing Neurology Clinic Medical Center, Nanjing, China
| | - Dan Yang
- Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Zhihong Ke
- Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Lili Huang
- Medical School, State Key Laboratory of Pharmaceutical Biotechnology, Department of Neurology, Drum Tower Hospital, Institute of Brain Science, Nanjing University, Nanjing, China
- Nanjing Neurology Clinic Medical Center, Nanjing, China
| | - Zhiyuan Yang
- Medical School, State Key Laboratory of Pharmaceutical Biotechnology, Department of Neurology, Drum Tower Hospital, Institute of Brain Science, Nanjing University, Nanjing, China
- Nanjing Neurology Clinic Medical Center, Nanjing, China
| | - Ruomeng Qin
- Medical School, State Key Laboratory of Pharmaceutical Biotechnology, Department of Neurology, Drum Tower Hospital, Institute of Brain Science, Nanjing University, Nanjing, China
- Nanjing Neurology Clinic Medical Center, Nanjing, China
| | - Yanan Huang
- Medical School, State Key Laboratory of Pharmaceutical Biotechnology, Department of Neurology, Drum Tower Hospital, Institute of Brain Science, Nanjing University, Nanjing, China
- Nanjing Neurology Clinic Medical Center, Nanjing, China
| | - Weiping Lv
- Medical School, State Key Laboratory of Pharmaceutical Biotechnology, Department of Neurology, Drum Tower Hospital, Institute of Brain Science, Nanjing University, Nanjing, China
- Nanjing Neurology Clinic Medical Center, Nanjing, China
| | - Zheqi Hu
- Medical School, State Key Laboratory of Pharmaceutical Biotechnology, Department of Neurology, Drum Tower Hospital, Institute of Brain Science, Nanjing University, Nanjing, China
- Nanjing Neurology Clinic Medical Center, Nanjing, China
| | - Yun Xu
- Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Medical School, State Key Laboratory of Pharmaceutical Biotechnology, Department of Neurology, Drum Tower Hospital, Institute of Brain Science, Nanjing University, Nanjing, China
- Nanjing Neurology Clinic Medical Center, Nanjing, China
- Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing, China
- Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing Drum Tower Hospital, Nanjing, China
- *Correspondence: Yun Xu,
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10
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Lam BYK, Cai Y, Akinyemi R, Biessels GJ, van den Brink H, Chen C, Cheung CW, Chow KN, Chung HKH, Duering M, Fu ST, Gustafson D, Hilal S, Hui VMH, Kalaria R, Kim S, Lam MLM, de Leeuw FE, Li ASM, Markus HS, Marseglia A, Zheng H, O'Brien J, Pantoni L, Sachdev PS, Smith EE, Wardlaw J, Mok VCT. The global burden of cerebral small vessel disease in low- and middle-income countries: A systematic review and meta-analysis. Int J Stroke 2023; 18:15-27. [PMID: 36282189 DOI: 10.1177/17474930221137019] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cerebral small vessel disease (cSVD) is a major cause of stroke and dementia. Previous studies on the prevalence of cSVD are mostly based on single geographically defined cohorts in high-income countries. Studies investigating the prevalence of cSVD in low- and middle-income countries (LMICs) are expanding but have not been systematically assessed. AIM This study aims to systematically review the prevalence of cSVD in LMICs. RESULTS Articles were searched from the Ovid MEDLINE and EMBASE databases from 1 January 2000 to 31 March 2022, without language restrictions. Title/abstract screening, full-text review, and data extraction were performed by two to seven independent reviewers. The prevalence of cSVD and study sample size were extracted by pre-defined world regions and health status. The Risk of Bias for Non-randomized Studies tool was used. The protocol was registered on PROSPERO (CRD42022311133). A meta-analysis of proportion was performed to assess the prevalence of different magnetic resonance imaging markers of cSVD, and a meta-regression was performed to investigate associations between cSVD prevalence and type of study, age, and male: female ratio. Of 2743 studies identified, 42 studies spanning 12 global regions were included in the systematic review. Most of the identified studies were from China (n = 23). The median prevalence of moderate-to-severe white matter hyperintensities (WMHs) was 20.5%, 40.5%, and 58.4% in the community, stroke, and dementia groups, respectively. The median prevalence of lacunes was 0.8% and 33.5% in the community and stroke groups. The median prevalence of cerebral microbleeds (CMBs) was 10.7% and 22.4% in the community and stroke groups. The median prevalence of moderate-to-severe perivascular spaces was 25.0% in the community. Meta-regression analyses showed that the weighted median age (51.4 ± 0.0 years old; range: 36.3-80.2) was a significant predictor of the prevalence of moderate-to-severe WMH and lacunes, while the type of study was a significant predictor of the prevalence of CMB. The heterogeneity of studies was high (>95%). Male participants were overrepresented. CONCLUSIONS This systematic review and meta-analysis provide data on cSVD prevalence in LMICs and demonstrated the high prevalence of the condition. cSVD research in LMICs is being published at an increasing rate, especially between 2010 and 2022. More data are particularly needed from Sub-Saharan Africa and Central Europe, Eastern Europe, and Central Asia.
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Affiliation(s)
- Bonnie Yin Ka Lam
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
- Gerald Choa Neuroscience Institute, Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Yuan Cai
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Rufus Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hilde van den Brink
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christopher Chen
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chin Wai Cheung
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - King Ngai Chow
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Henry Kwun Hang Chung
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Marco Duering
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
- Medical Image Analysis Center (MIAC), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Siu Ting Fu
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Deborah Gustafson
- Section for NeuroEpidemiology, Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Saima Hilal
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore
| | - Vincent Ming Ho Hui
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
- Gerald Choa Neuroscience Institute, Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Rajesh Kalaria
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - SangYun Kim
- Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Maggie Li Man Lam
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Frank Erik de Leeuw
- Donders Institute for Brain Cognition and Behaviour, Department of Neurology, Radboudumc, Nijmegen, The Netherlands
| | - Ami Sin Man Li
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
- Gerald Choa Neuroscience Institute, Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hugh Stephen Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Anna Marseglia
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Huijing Zheng
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
- Gerald Choa Neuroscience Institute, Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - John O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Leonardo Pantoni
- Stroke and Dementia Lab, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Perminder Singh Sachdev
- School of Psychiatry, Neuropsychiatric Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Eric E Smith
- Division of Neurology, Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Vincent Chung Tong Mok
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
- Gerald Choa Neuroscience Institute, Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong
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11
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Hou Y, Yang S, Li Y, Qin W, Yang L, Hu W. Association of enlarged perivascular spaces with upper extremities and gait impairment: An observational, prospective cohort study. Front Neurol 2022; 13:993979. [DOI: 10.3389/fneur.2022.993979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objectiveGait disturbances are common in the elderly and can lead to the loss of functional independence and even death. Enlarged perivascular space (EPVS) and motor performance may be related, but only few studies have explored this relationship. The aim of our study was to investigate the effects of both the severity and location of EPVS on movement disorders.MethodTwo hundred and six participants aged between 45 and 85 years old with complete magnetic resonance imaging (MRI) data were included in our analysis. EPVS were divided into basal ganglia (BG) and centrum semiovale (CSO), and their grades were measured. Gait was assessed quantitatively using a 4-m walkway and TUG test as well as semi-quantitatively using the Tinetti and SPPB tests. The function of upper extremities was evaluated by 10-repeat pronation–supination, 10-repeat finger-tapping, and 10-repeat opening and closing of the hands.ResultsBoth high-grade EPVS, whether in BG and CSO, were independently correlated with gait parameters, the TUG time, Tinetti, and SPPB tests. The EPVS located in BG had a significant association with 10-repeat finger-tapping time (β = 0.231, P = 0.025) and a similar association was also observed between CSO-EPVS and 10-repeat pronation–supination time (β = 0.228, P = 0.014).ConclusionOur results indicated that EPVS was associated with gait disturbances, and a further investigation found that EPVS has an association with upper extremities disorder. EPVS should be considered as a potential target for delaying gait and upper extremities damage since CSVD can be prevented to some extent.
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12
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Sharma B, Gee M, Nelles K, Cox E, Irving E, Saad F, Yuan J, McCreary CR, Ismail Z, Camicioli R, Smith EE. Gait in Cerebral Amyloid Angiopathy. J Am Heart Assoc 2022; 11:e025886. [PMID: 36129041 DOI: 10.1161/jaha.121.025886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Gait is a complex task requiring coordinated efforts of multiple brain networks. To date, there is little evidence on whether gait is altered in cerebral amyloid angiopathy (CAA). We aimed to identify impairments in gait performance and associations between gait impairment and neuroimaging markers of CAA, cognition, and falls. Methods and Results Gait was assessed using the Zeno Walkway during preferred pace and dual task walks, and grouped into gait domains (Rhythm, Pace, Postural Control, and Variability). Participants underwent neuropsychological testing and neuroimaging. Falls and fear of falling were assessed through self-report questionnaires. Gait domain scores were standardized and analyzed using linear regression adjusting for age, sex, height, and other covariates. Participants were patients with CAA (n=29), Alzheimer disease with mild dementia (n=16), mild cognitive impairment (n=24), and normal elderly controls (n=47). CAA and Alzheimer disease had similarly impaired Rhythm, Pace, and Variability, and higher dual task cost than normal controls or mild cognitive impairment. Higher Pace score was associated with better global cognition, processing speed, and memory. Gait measures were not correlated with microbleed count or white matter hyperintensity volume. Number of falls was not associated with gait domain scores, but participants with low fear of falling had higher Pace (odds ratio [OR], 2.61 [95% CI, 1.59-4.29]) and lower Variability (OR, 1.64 [95% CI, 1.10-2.44]). Conclusions CAA is associated with slower walking, abnormal rhythm, and greater gait variability than in healthy controls. Future research is needed to identify the mechanisms underlying gait impairments in CAA, and whether they predict future falls.
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Affiliation(s)
- Breni Sharma
- Cumming School of Medicine University of Calgary Alberta Canada.,Hotchkiss Brain Institute University of Calgary Alberta Canada
| | - Myrlene Gee
- Department of Medicine (Neurology) University of Alberta Edmonton Alberta Canada
| | - Krista Nelles
- Department of Medicine (Neurology) University of Alberta Edmonton Alberta Canada
| | - Emily Cox
- Hotchkiss Brain Institute University of Calgary Alberta Canada.,Department of Clinical Neurosciences University of Calgary Alberta Canada
| | - Elisabeth Irving
- Hotchkiss Brain Institute University of Calgary Alberta Canada.,Department of Clinical Neurosciences University of Calgary Alberta Canada
| | - Feryal Saad
- Hotchkiss Brain Institute University of Calgary Alberta Canada.,Department of Clinical Neurosciences University of Calgary Alberta Canada.,Seaman Family MR Research Centre University of Calgary Alberta Canada
| | - Jerald Yuan
- Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta Canada
| | - Cheryl R McCreary
- Hotchkiss Brain Institute University of Calgary Alberta Canada.,Department of Clinical Neurosciences University of Calgary Alberta Canada.,Seaman Family MR Research Centre University of Calgary Alberta Canada
| | - Zahinoor Ismail
- Cumming School of Medicine University of Calgary Alberta Canada.,Hotchkiss Brain Institute University of Calgary Alberta Canada.,Department of Clinical Neurosciences University of Calgary Alberta Canada.,Seaman Family MR Research Centre University of Calgary Alberta Canada.,Departments of Psychiatry and Community Health Sciences University of Calgary Alberta Canada
| | - Richard Camicioli
- Department of Medicine (Neurology) University of Alberta Edmonton Alberta Canada.,Neuroscience and Mental Health Institute University of Alberta Edmonton Alberta Canada
| | - Eric E Smith
- Cumming School of Medicine University of Calgary Alberta Canada.,Hotchkiss Brain Institute University of Calgary Alberta Canada.,Department of Clinical Neurosciences University of Calgary Alberta Canada.,Seaman Family MR Research Centre University of Calgary Alberta Canada
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13
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Hou Y, Yang S, Li Y, Qin W, Yang L, Hu W. The Correlation Between Modified Total Cerebral Small Vessel Disease Score and Gait and Balance Disorder in Middle-aged to Older Adults. Curr Neurovasc Res 2022; 19:358-366. [PMID: 36089793 DOI: 10.2174/1567202619666220908113144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS The aim of this study is to investigate the relationships between the original and modified total cerebral Small Vessel Disease (CSVD) score and gait and balance impairment using quantitative and semi-quantitative tests. METHODS In our study, patients aged 45 to 85 consecutively recruited. CSVD manifestations were identified with brain Magnetic Resonance Imaging (MRI), and the original and modified CSVD scores were calculated based on the results. Gait and balance function were assessed using both gait parameters and clinical rating scales. The correlation between the original and modified total scores of the CSVD and gait and balance dysfunction was demonstrated. RESULTS 224 patients were enrolled in the study. Gait and balance disorders were associated with both the original and modified CSVD scores. A significant association remained after adjusting for gender, height, age, hypertension, and other relevant risk factors. The binary logistic regression and chi-squared trend tests revealed that impairment of movement function significantly correlated with the modified CSVD score and that the dysfunction was significantly higher for patients with modified CSVD scores of 5-6 than those with scores of 1-2. In Receiver Operating Characteristic (ROC) analysis, modified CSVD scores were more accurate in predicting gait impairment than original CSVD scores. CONCLUSION We found both original and modified total CSVD scores to be related to gait and balance disorder, and the modified CSVD score was more accurate in identifying movement impairment and should be used as an effective tool in investigating CSVD and motor dysfunction.
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Affiliation(s)
- Yutong Hou
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shuna Yang
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yue Li
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wei Qin
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lei Yang
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wenli Hu
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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14
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Su C, Yang X, Wei S, Zhao R. Periventricular white matter hyperintensities are associated with gait and balance in patients with minor stroke. Front Neurol 2022; 13:941668. [PMID: 35937058 PMCID: PMC9355320 DOI: 10.3389/fneur.2022.941668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveCerebral small vessel disease (CSVD) is associated with gait and balance deficits in older adults. However, the effect of CSVD-related brain injury on post-stroke mobility is unknown. This study aimed to investigate the association of CSVD with gait and balance impairment after a minor stroke.MethodsA total of 273 patients with a minor stroke (NIHSS ≤ 5 points) who were hospitalized at the Affiliated Hospital of Qingdao University were enrolled. The manifestations of white matter hyperintensities (WMH), lacunes, enlarged perivascular spaces (EPVS), and cerebral microbleeds (CMB) were statistically analyzed according to magnetic resonance imaging results, and the total burden score of CSVD was calculated. Gait function was assessed by a 6-m walking speed test, and balance function was assessed by the timed-up-and-go (TUG) test. Linear regression analysis was applied to determine the association after adjusting for key variables.ResultsThe correlation results showed that in patients with minor stroke, age, sex, smoking history, and the infarct site were associated with gait speed, and age and the infarct site were associated with the TUG test. In the univariate linear regression model, periventricular white matter hyperintensities (PVWMH), deep white matter hyperintensities (DWMH), and the total burden of CSVD were correlated with gait speed, while only PVWMH correlated with the TUG test. After adjusting for confounders, only PVWMH were independent predictors of gait speed (β = −0.089, p < 0.05) and the TUG test (β = 0.517, p < 0.05).ConclusionsOur study confirmed that CSVD is associated with gait and balance disorders after a minor stroke. PVWMH are independent predictors of gait and balance disorders in patients with minor stroke. These findings should be confirmed in larger prospective studies.
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15
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Wang Y, Jiang Y, Lu H, Tian W, Li P, Xu K, Fan M, Zhao X, Dong Q, Jin L, Chen J, Cui M, Chen X. Cross-sectional associations between cortical thickness and independent gait domains in older adults. J Am Geriatr Soc 2022; 70:2610-2620. [PMID: 35510857 DOI: 10.1111/jgs.17840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/17/2022] [Accepted: 04/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although the prevalence of gait disturbance is increasing with population aging, our understanding of its underlying neural basis is still limited. The precise brain regions linked to specific gait domains have not been well defined. In this study, we aim to investigate the associations of cortical thickness and different gait domains, and to explore whether these associations could be explained by cerebral small vessel disease. METHODS A total of 707 community-dwelling participants from the Taizhou Imaging Study (mean age: 60.2 ± 3.0 years, 57.4% female) were involved. All participants underwent brain MRI and gait assessment. We obtained quantitative gait parameters using wearable devices and then summarized them into three independent gait domains through factor analysis. Cortical thickness was analyzed and visualized using FreeSurfer and Surfstat. RESULTS Three independent domains (pace, rhythm, and variability) were summarized from 12 gait parameters. Among gait domains, poorer pace was associated with the thinner cortical thickness of multiple regions, which included areas related with motor function (e.g., the primary motor cortex, premotor cortex, and supplementary motor area), sensory function (e.g., the postcentral gyrus and paracentral lobule), visuospatial attention (e.g., the lateral occipital cortex and lingual gyrus), and identification and cognition (e.g., the fusiform gyrus and entorhinal cortex). Such a relationship was only slightly attenuated after adjustment for cerebrovascular risk factors and cerebral small vessel disease. No statistically significant association was found between cortical thickness and the rhythm or variability domains. CONCLUSIONS Poorer pace is independently associated with thinner cortical thickness in areas important for motor, sensory, cognitive function, and visuospatial attention. Our study emphasizes the importance of cortical thickness in gait control and adds value in investigating neural mechanisms of gait.
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Affiliation(s)
- Yingzhe Wang
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, Zhangjiang Fudan International Innovation Center, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Yanfeng Jiang
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, Zhangjiang Fudan International Innovation Center, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Heyang Lu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Weizhong Tian
- Department of Medical Imaging, Hospital Affiliated 5 to Nantong University (Taizhou People's Hospital), Taizhou, China.,Department of Medical Imaging, Taizhou People's Hospital, Taizhou, China
| | - Peixi Li
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Kelin Xu
- Fudan University Taizhou Institute of Health Sciences, Taizhou, China.,Department of Biostatistics, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Min Fan
- Taixing Disease Control and Prevention Center, Taizhou, China
| | - Xiaolan Zhao
- Taizhou Disease Control and Prevention Center, Taizhou, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Jin
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, Zhangjiang Fudan International Innovation Center, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Jinhua Chen
- Department of Medical Imaging, Hospital Affiliated 5 to Nantong University (Taizhou People's Hospital), Taizhou, China.,Department of Medical Imaging, Taizhou People's Hospital, Taizhou, China
| | - Mei Cui
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xingdong Chen
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, Zhangjiang Fudan International Innovation Center, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China.,Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,Yiwu Research Institute of Fudan University, Yiwu, China
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16
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Qiu Q, Zhou X, Wu L, Zhang Y, Yu Z, Wang M, Huang H, Luo X, Pan D. Serum Cortisol Is Associated With Cerebral Small Vessel Disease-Related Brain Changes and Cognitive Impairment. Front Aging Neurosci 2022; 13:809684. [PMID: 35126094 PMCID: PMC8814515 DOI: 10.3389/fnagi.2021.809684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/31/2021] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the relationship between serum cortisol, cerebral small vessel disease (CSVD) neuroimaging markers, and cognitive performance. Methods We recruited patients over 50 years old who attended our hospital for physical examination between November 2020 and July 2021. All participants were subject to brain magnetic resonance imaging (MRI), serum cortisol examination, and the Montreal cognitive function assessment (MoCA). On brain MRI, we scored the presence of each marker of CSVD, including white matter hyperintensity (WMH), lacunes, cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVS). One point was awarded for the presence of each marker, producing a score between 0 and 4. Results In total, 158 participants were included in this study with a mean age of 60.5 (56.0–66.3) years; 55.1% were male. In the multivariable analyses, serum cortisol level was an independent predictor of WMH severity, the presence of lacunes/CMBs, moderate-severe EPVS and total CSVD burden after adjusting for confounding factors. Serum cortisol level had positive associations with periventricular/deep Fazekas score, burdens of lacunes/CMBs, moderate-severe EPVS, and total CSVD burden in dose-dependent manner, and was an independent predictor of cognitive impairment. Furthermore, the results of the receiver operating characteristic (ROC) curve analysis revealed an area under curve (AUC) of 0.745 with 64.1% sensitivity and 82.5% specificity, and an AUC of 0.705 with 52.1% sensitivity and 85.5 specificity of cortisol in detecting patients with high CSVD burden and MCI, respectively. Conclusions Serum cortisol level is independently associated with each CSVD MRI markers, total CSVD burden and cognitive impairment. These findings provide clues for pathological mechanisms and suggest serum cortisol as a promising biomarker associated with CSVD.
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Ogama N, Endo H, Satake S, Niida S, Arai H, Sakurai T. Impact of regional white matter hyperintensities on specific gait function in Alzheimer's disease and mild cognitive impairment. J Cachexia Sarcopenia Muscle 2021; 12:2045-2055. [PMID: 34585518 PMCID: PMC8718089 DOI: 10.1002/jcsm.12807] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/01/2021] [Accepted: 08/23/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Gait disturbance and musculoskeletal changes are evident in persons living with Alzheimer's disease (AD). Because complex gait control requires the integration of neural networks, cerebral small vessel disease (SVD), which is highly prevalent in persons with AD, might have an additional impact on gait disturbance. This study investigated whether white matter hyperintensities (WMH) are more predominantly associated with gait disturbance in persons with AD than in individuals with mild cognitive impairment (MCI) and normal cognition (NC) and further identified the regional impact of WMH on specific gait changes. METHODS This study included 396 subjects (aged 65 to 86 years, 63.9% female) diagnosed with AD (n = 187), MCI (n = 118), or NC (n = 91). WMH, lacunes, perivascular spaces, and cerebral microbleeds were assessed as markers of SVD. The volume of WMH was quantified in each brain lobe (frontal, temporal, occipital, and parietal) and sublobar regions in the basal ganglia and thalamus. Gait function was assessed using an electronic walkway. We investigated the association between regional WMH and gait disturbance in individuals with AD, MCI, and NC, adjusted for classical and musculoskeletal confounders. RESULTS Among markers of SVD, WMH were most associated with gait disturbance. In AD subjects, periventricular WMH in the frontal and parietal lobes were associated with slow gait speed (rs = -0.21, P = 0.007 and rs = -0.18, P = 0.019, respectively). These lesions were also associated with changes in stride time, double-leg support time, and walking angle (all rs > 0.20, P < 0.01). Lesions in the basal ganglia and thalamus were associated with slow gait speed (rs = -0.16, P = 0.034 and rs = -0.18, P = 0.023, respectively) and greater gait speed variability (rs = 0.16, P = 0.034 and rs = 0.20, P = 0.010, respectively). MCI subjects showed only associations between sublobar lesions and shorter stride length (rs = -0.24, P = 0.016) and increased walking angle (rs = 0.32, P = 0.002). NC subjects did not show associations between WMH and gait parameters. MCI and NC subjects were more affected by muscle weakness than WMH for global gait function (rs = 0.42, P < 0.001 and rs = 0.23, P = 0.046, respectively). CONCLUSIONS Persons with AD showed a predominant association between WMH and gait disturbance compared with MCI and NC subjects, and regional WMH had a detrimental effect on specific gait changes.
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Affiliation(s)
- Noriko Ogama
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidetoshi Endo
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shosuke Satake
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shumpei Niida
- Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
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18
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Cai M, Jacob MA, Norris DG, de Leeuw FE, Tuladhar AM. Longitudinal relation between structural network efficiency, cognition, and gait in cerebral small vessel disease. J Gerontol A Biol Sci Med Sci 2021; 77:554-560. [PMID: 34459914 PMCID: PMC8893255 DOI: 10.1093/gerona/glab247] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Indexed: 12/03/2022] Open
Abstract
Background To investigate changes in gait performance over time and how these changes are associated with the decline in structural network efficiency and cognition in older patients with cerebral small vessel disease (SVD). Methods In a prospective, single-center cohort with 217 older participants with SVD, we performed 1.5T MRI scans, cognitive tests, and gait assessments evaluated by Timed UP and Go (TUG) test twice over 4 years. We reconstructed the white matter network for each subject based on diffusion tensor imaging tractography, followed by graph-theoretical analyses to compute the global efficiency. Conventional MRI markers for SVD, that is, white matter hyperintensity (WMH) volume, number of lacunes, and microbleeds, were assessed. Results Baseline global efficiency was not related to changes in gait performance, while decline in global efficiency over time was significantly associated with gait decline (ie, increase in TUG time), independent of conventional MRI markers for SVD. Neither baseline cognitive performance nor cognitive decline was associated with gait decline. Conclusions We found that disruption of the white matter structural network was associated with gait decline over time, while the effect of cognitive decline was not. This suggests that structural network disruption has an important role in explaining the pathophysiology of gait decline in older patients with SVD, independent of cognitive decline.
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Affiliation(s)
- Mengfei Cai
- Department of Neurology, Radboud University Medical Center; Donders Institute for Brain, Cognition, and Behaviour, Nijmegen; The Netherlands
| | - Mina A Jacob
- Department of Neurology, Radboud University Medical Center; Donders Institute for Brain, Cognition, and Behaviour, Nijmegen; The Netherlands
| | - David G Norris
- Center for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Medical Center; Donders Institute for Brain, Cognition, and Behaviour, Nijmegen; The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Radboud University Medical Center; Donders Institute for Brain, Cognition, and Behaviour, Nijmegen; The Netherlands
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Liu T, Liu Y, Wang S, Du X, Zheng Z, Wang N, Hou X, Shen C, Chen J, Liu X. Brachial-Ankle Pulse Wave Velocity is Related to the Total Cerebral Small-Vessel Disease Score in an Apparently Healthy Asymptomatic Population. J Stroke Cerebrovasc Dis 2020; 29:105221. [PMID: 33066883 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Cerebral small-vessel disease (CSVD) is an extensive cerebrovascular disease associated with many poor outcomes. Previous studies have shown that brachial-ankle pulse wave velocity (baPWV) is related to various neuroimaging signatures, but its association with the total CSVD burden remains unknown. We aimed to explore whether baPWV is related to the total CSVD score and to establish a cutoff for detecting the presence and severity of CSVD, which may guide clinical preventive measures. METHODS We retrospectively selected 684 neurologically healthy participants to explore correlations between baPWV and the total CSVD score and each of its components (lacunes, white matter hyperintensity (WMH), perivascular space (PVS), and cerebral microbleeds (CMBs)). Subsequently, we established two receiver operating characteristic (ROC) curves to study the effectiveness of baPWV in predicting CSVD (scores 1-4) and severe CSVD (scores 3-4). RESULTS The median baPWV was 13.16 m/s, which increased significantly with increasing scores (0-4). BaPWV was significantly higher among persons with each component of the total CSVD score than among those without any components. Multivariable ordinal logistic regression analyses showed that a one-unit (m/s) change in baPWV significantly increased the total CSVD score by 0.012. The optimal baPWV cutoffs for detecting CSVD and severe CSVD were 13.12 m/s and 15.63 m/s, respectively. CONCLUSIONS BaPWV was positively correlated with the total CSVD score, suggesting that baPWV measurement is a useful method for early diagnosis of CSVD, which may contribute to preventing and controlling CSVD progression in the general population of China.
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Affiliation(s)
- Tiantian Liu
- Department of Senile Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; Department of Neurology, Weifang People's Hospital, Weifang, Shandong 261021, China
| | - Yuanyuan Liu
- Department of Cardiology, Qingzhou People's Hospital, Weifang, Shandong 262500, China
| | - Shuhua Wang
- Health Management Center, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
| | - Xiaolong Du
- Department of Neurosurgery, Weifang People's Hospital, Weifang, Shandong 261021, China
| | - Zhaofeng Zheng
- Department of Radiology, Weifang People's Hospital, Weifang, Shandong 261021, China
| | - Ning Wang
- Imaging Center, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
| | - Xunyao Hou
- Department of Senile Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; Department of Senile Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Chao Shen
- Department of Senile Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; Department of Senile Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Jian Chen
- Department of Senile Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; Department of Senile Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Xueping Liu
- Department of Senile Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; Department of Senile Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
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Jiang Y, Cui M, Tian W, Zhu S, Chen J, Suo C, Liu Z, Lu M, Xu K, Fan M, Wang J, Dong Q, Ye W, Jin L, Chen X. Lifestyle, multi-omics features, and preclinical dementia among Chinese: The Taizhou Imaging Study. Alzheimers Dement 2020; 17:18-28. [PMID: 32776666 DOI: 10.1002/alz.12171] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/01/2020] [Accepted: 07/11/2020] [Indexed: 12/14/2022]
Abstract
China has the largest number of patients with dementia in the world. However, dementia in the Chinese population is still poorly understood and under-researched. Given the differences in genetic, demographic, sociocultural, lifestyle, and health profiles among Chinese and other ethnic/racial groups, it is crucial to build appropriate infrastructure for long-term longitudinal studies to advance Chinese cognitive aging and dementia research. We initiated a community-based prospective cohort-the Taizhou Imaging Study (TIS)-to accelerate the understanding of dementia and cerebrovascular diseases in Chinese. This article presents the rationale, aims, study design, and organization of TIS. In addition, we described some examples of the types of studies such a resource might support. The TIS provides a new framework for facilitating Chinese dementia research, encompassing invaluable resources including detailed epidemiological, sociocultural, neuroimaging, and omics data.
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Affiliation(s)
- Yanfeng Jiang
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
| | - Mei Cui
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Weizhong Tian
- Department of Medical Imaging, Taizhou People's Hospital Affiliated to Nantong University, Taizhou, Jiangsu, China
| | - Sibo Zhu
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China.,Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Jinhua Chen
- Department of Medical Imaging, Taizhou People's Hospital Affiliated to Nantong University, Taizhou, Jiangsu, China
| | - Chen Suo
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China.,Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Zhenqiu Liu
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
| | - Ming Lu
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China.,Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Kelin Xu
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China.,Department of Biostatistics, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Min Fan
- Taixing Disease Control and Prevention Center, Taizhou, Jiangsu, China
| | - Jiucun Wang
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Weimin Ye
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Li Jin
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
| | - Xingdong Chen
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
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Xu M, Huang M, Qiang D, Gu J, Li Y, Pan Y, Yao X, Xu W, Tao Y, Zhou Y, Ma H. Hypertriglyceridemic Waist Phenotype and Lipid Accumulation Product: Two Comprehensive Obese Indicators of Waist Circumference and Triglyceride to Predict Type 2 Diabetes Mellitus in Chinese Population. J Diabetes Res 2020; 2020:9157430. [PMID: 33344653 PMCID: PMC7725575 DOI: 10.1155/2020/9157430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/23/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To determine whether hypertriglyceridemic waist (HTGW) and high lipid accumulation product (LAP) preceded the incidence of type 2 diabetes mellitus (T2DM), and to investigate the interactions of HTGW and LAP with other components of metabolic syndrome on the risk of T2DM. METHODS A total of 15,717 eligible participants without baseline T2DM and aged 35 and over were included from a Chinese rural cohort. Cox proportional hazards regression models were used to estimate the association of HTGW and LAP with the incidence of T2DM, and the restricted cubic spline model was used to evaluate the dose-response association. RESULTS Overall, 867 new T2DM cases were diagnosed after 7.77 years of follow-up. Participants with HTGW had a higher hazard ratio for T2DM (hazard ratio (HR): 6.249, 95% confidence interval (CI): 5.199-7.511) after adjustment for potential confounders. The risk of incident T2DM was increased with quartiles 3 and 4 versus quartile 1 of LAP, and the adjusted HRs (95% CIs) were 2.903 (2.226-3.784) and 6.298 (4.911-8.077), respectively. There were additive interactions of HTGW (synergy index (SI): 1.678, 95% CI: 1.358-2.072) and high LAP (SI: 1.701, 95% CI: 1.406-2.059) with increased fasting plasma glucose (FPG) on the risk of T2DM. Additionally, a nonlinear (P nonlinear < 0.001) dose-response association was found between LAP and T2DM. CONCLUSION The subjects with HTGW and high LAP were at high risk of developing T2DM, and the association between LAP and the risk of T2DM may be nonlinear. Our study further demonstrates additive interactions of HTGW and high LAP with increased FPG on the risk of T2DM.
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Affiliation(s)
- Minrui Xu
- Wujin District Center for Disease Prevention and Control, Changzhou, Jiangsu, China
| | - Mingtao Huang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Prenatal Diagnosis, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
| | - Deren Qiang
- Wujin District Center for Disease Prevention and Control, Changzhou, Jiangsu, China
| | - Jianxin Gu
- Wujin District Center for Disease Prevention and Control, Changzhou, Jiangsu, China
| | - Yong Li
- Wujin District Center for Disease Prevention and Control, Changzhou, Jiangsu, China
| | - Yingzi Pan
- Wujin District Center for Disease Prevention and Control, Changzhou, Jiangsu, China
| | - Xingjuan Yao
- Changzhou Center for Disease Prevention and Control, Changzhou, Jiangsu, China
| | - Wenchao Xu
- Changzhou Center for Disease Prevention and Control, Changzhou, Jiangsu, China
| | - Yuan Tao
- Department of Medical Affairs, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Yihong Zhou
- Wujin District Center for Disease Prevention and Control, Changzhou, Jiangsu, China
| | - Hongxia Ma
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
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