Department of Medicine, Division of Geriatric Medicine,Parkwood Hospital, St. Joseph's Health Care London, London, ON, Canada.
Panminerva Med. 2012 Sep;54(3):189-204.
Vascular brain burden, evaluated as white matter hyperintensities (WMH), may explain in part the higher-level gait disorders found in older adults. However, the magnitude and location of WMH as a determinant of higher-level gait disorders remain unknown. The purpose of this review was to determine if the magnitude and distribution of WMH would be associated with the presence of gait disorders in older adults. Medline was searched using the following keywords: "gait", "gait disorders, neurologic", "walking", "cerebrovascular disorders", "leukoaraiosis", "leukoencephalopathies" and "aged". Additional references were reviewed from the bibliographies, and from citation searches on key articles. Observational studies, without language restriction, published between 1995-2011 and exploring simultaneously WMH on MRI and gait performance were selected. Twenty-one studies met the selection criteria. The number of participants per study ranged from 14 to 3301 (35% to 75% female). The total WMH burden was associated with gait disorders in all studies. The largest WMH fractions associated with gait disorders were found in the frontal lobe, the centrum semiovale, the posterior limb of internal capsule, the genu and the splenium of corpus callosum. Gait velocity, stride length and step width were the gait parameters most commonly affected in the presence of WMH. The brain mapping literature supports the hypothesis that a high WMH burden is associated with gait disorders in the course of aging. This could give rise to new strategies for the prevention of higher-level gait disorders and falls in the elderly based on the management of cerebrovascular disease.
血管性脑负担，评估为脑白质高信号（WMH），可能部分解释了老年人中更高水平的步态障碍。然而，WMH 的程度和位置作为更高水平的步态障碍的决定因素仍然未知。本综述的目的是确定 WMH 的程度和分布是否与老年人步态障碍的存在相关。使用以下关键词在 Medline 上进行搜索：“步态”，“神经步态障碍”，“行走”，“脑血管疾病”，“脑白质疏松症”，“脑白质病”和“老年人”。从参考文献中回顾了其他参考文献，并从关键文章的引文搜索中进行了回顾。选择了 1995 年至 2011 年间发表的、同时探索 MRI 上的 WMH 和步态表现的观察性研究，无语言限制。符合选择标准的研究有 21 项。每项研究的参与者人数从 14 到 3301 人不等（35％至 75％为女性）。所有研究均表明总 WMH 负担与步态障碍相关。与步态障碍相关性最大的 WMH 分数出现在额叶、半卵圆中心、内囊后肢、胼胝体膝部和压部。步态参数中最常受影响的是步态速度、步幅和步宽。脑图谱文献支持这样一种假设，即高 WMH 负担与衰老过程中的步态障碍有关。这可能为基于脑血管疾病管理的老年人更高水平的步态障碍和跌倒的预防提供新的策略。
