Radboud University Medical Center; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands.
Center for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
Neuroimage Clin. 2021;30:102667. doi: 10.1016/j.nicl.2021.102667. Epub 2021 Apr 20.
Cerebral small vessel disease (SVD), including white matter hyperintensities (WMH), microbleeds, lacunes, was related to gait disturbances, while the underlying mechanism is unclear. Here, we investigated the relation between structural network efficiency, cognition and gait performance in 272 elderly subjects with SVD. All participants underwent 1.5 T MRI, gait and neuropsychological assessment. Conventional MRI markers for SVD, i.e. WMH volume, number of lacunes and microbleeds, were assessed. Diffusion tensor imaging-based tractography was used to reconstruct the brain network for each individual, followed by graph-theoretical analyses to compute the well-established network measure, global efficiency. We found that lower global efficiency was associated with worse gait performance, including slower gait speed and shorter stride length, independent of conventional MRI markers for SVD. This association was partly mediated via cognitive function. We identified subnetworks of white matter connections associated with gait and cognition, characterized by dominant involvement of frontal tracts. Our findings suggest that network disruption is associated with gait disturbances through cognitive dysfunction in elderly with SVD. Gait is a highly cognitive process and the crucial role of cognition should be considered when investigating gait disturbances in the elderly with SVD.
脑小血管病（SVD）包括脑白质高信号（WMH）、微出血、腔隙等，与步态障碍有关，但其潜在机制尚不清楚。在这里，我们研究了 272 例 SVD 老年患者的结构网络效率、认知和步态表现之间的关系。所有参与者均接受了 1.5T MRI、步态和神经心理学评估。评估了 SVD 的常规 MRI 标志物，即 WMH 体积、腔隙数量和微出血数量。基于弥散张量成像的束追踪用于重建每个人的大脑网络，然后进行图论分析以计算公认的网络度量——全局效率。我们发现，较低的全局效率与较差的步态表现相关，包括较慢的步速和较短的步长，这与 SVD 的常规 MRI 标志物无关。这种关联部分通过认知功能来介导。我们确定了与步态和认知相关的白质连接子网络，其特征是额叶束的主要参与。我们的研究结果表明，在 SVD 老年患者中，网络中断与认知功能障碍相关的步态障碍有关。步态是一个高度认知的过程，在研究 SVD 老年患者的步态障碍时，应考虑认知的关键作用。
