Highlights
Gait abnormalities and falls after stroke are important problems and are under-researched. This systematic review of poor gait patterns in conditions typically associated with increased falls, such as cerebral small vessel disease (CSVD; defined primarily by neuroimaging markers), mild cognitive impairment (MCI; both amnestic and non-amnestic) and dementia (Alzheimer’s, vascular disease and dementia with Lewy bodies).
Gait outcomes were divided into qualitative (apraxia, hemiparetic gait, etc.), semiquantitative (measured using clinical scales such as the Timed Up and Go scale), and quantitative gait metrics (measured using sophisticated indices such as length variability). of the step).
Not only were white and gray matter diseases in various deep subcortical structures associated with mobility impairment and slower gait, decreased gait was observed with CSVD progression even without dementia. Gait abnormalities were seen more frequently in vascular MCI and dementia or dementia with Lewy bodies than in Alzheimer’s dementia.
This study highlights the role of cerebral small vessel disease (CSVD) in gait abnormalities.
Aggressive modifications of vascular risk factors and prevention of CSVD progression can potentially improve mobility outcome and prevent falls in the aging population.
Summary
Background
The interrelationships between gait, cerebral small vessel disease (CSVD), and cognitive impairments in aging are not well understood, despite their common coexistence.
Aim
To systematically review studies of gait impairment in CSVD, pre-dementia and dementia and identify key gaps for future research and novel avenues towards intervention.
Methods
A PRISMA-guided search strategy was implemented in PubMed to identify relevant studies. Two reviewers screened potential articles (n=263) published before December 1, 2021. Studies with sample sizes > 20 and that included any adult over 65 years of age (n=202) were included.
Results
The key findings were that:
1) Gait disorders and cognitive outcomes were associated with various cerebral small vessel disease (CSVD) pathologies distributed throughout the brain
2) Poor gait pathologies and CSVD were more strongly associated with vascular dementia, rather than Alzheimer’s disease.
Discussion
Better understanding of the interrelationships between gait performance in cerebral small vessel disease (CSVD), predementia, and dementia requires studies that examine a) comprehensive patterns in the clinical manifestations of CSVD, b) racially diverse samples /ethnically, c) samples followed for long periods or across adult life, d) non-traditional CSVD neuroimaging markers (e.g., resting-state fMRI), and e) continuous gait performance (e.g. ., wearable sensors) and complex (e.g., dual task).
