Division of Geriatric Medicine, Department of Medicine, Parkwood Hospital, St. Joseph's Health Care, London, Ontario, Canada.
Am J Alzheimers Dis Other Demen. 2012 Sep;27(6):371-80. doi: 10.1177/1533317512454710.
Although gait disorders are common in Alzheimer's disease (AD), determining which brain structures and related lesions are specifically involved is a goal yet to be reached. Our objective was to systematically review all published data that examined associations between gait disorders and brain imaging in AD. Of 486 selected studies, 4 observational studies met the selection criteria. The number of participants ranged from 2 to 61 community dwellers (29%-100% female) with prodromal or dementia-stage AD. Quantitative gait disorders (ie, slower gait velocity explained by shorter stride length) were associated with white matter lesions, mainly in the medial frontal lobes and basal ganglia. The nigrostriatal dopamine system was unaffected. Qualitative gait disorders (ie, higher stride length variability) correlated with lower hippocampal volume and function. Gait disorders in AD could be explained by a high burden of age-related subcortical hyperintensities on the frontal-subcortical circuits (nonspecific) together with hippocampal atrophy and hypometabolism (specific).
虽然步态障碍在阿尔茨海默病（AD）中很常见，但确定哪些大脑结构和相关病变具体涉及其中是一个尚未实现的目标。我们的目的是系统地回顾所有已发表的研究数据，这些数据检查了 AD 患者的步态障碍与脑影像学之间的关联。在 486 项选定的研究中，有 4 项观察性研究符合选择标准。参与者人数从 2 名到 61 名社区居住者不等（女性占 29%到 100%），患有前驱期或痴呆期 AD。定量步态障碍（即由于步幅变短导致的步行速度较慢）与白质病变有关，主要位于额内侧回和基底节。黑质纹状体多巴胺系统未受影响。定性步态障碍（即步长变异性增加）与海马体体积和功能降低有关。AD 中的步态障碍可以用额皮质下回路（非特异性）的年龄相关性皮质下高信号的高负担以及海马体萎缩和低代谢（特异性）来解释。
