Gait and Brain Lab, St. Joseph's Hospital, Parkwood Institute, Lawson Health Research Institute, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Neuroscience, Mobility and Balance Lab (NiMBaL), Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada.
Neurorehabil Neural Repair. 2023 Jul;37(7):434-443. doi: 10.1177/15459683231177606. Epub 2023 Jun 2.
BACKGROUND: Acute change in gait speed while performing a mental task [dual-task gait cost (DTC)], and hyperintensity magnetic resonance imaging signals in white matter are both important disability predictors in older individuals with history of stroke (poststroke). It is still unclear, however, whether DTC is associated with overall hyperintensity volume from specific major brain regions in poststroke. METHODS: This is a cohort study with a total of 123 older (69 ± 7 years of age) participants with history of stroke were included from the Ontario Neurodegenerative Disease Research Initiative. Participants were clinically assessed and had gait performance assessed under single- and dual-task conditions. Structural neuroimaging data were analyzed to measure both, white matter hyperintensity (WMH) and normal appearing volumes. Percentage of WMH volume in frontal, parietal, occipital, and temporal lobes as well as subcortical hyperintensities in basal ganglia + thalamus were the main outcomes. Multivariate models investigated associations between DTC and hyperintensity volumes, adjusted for age, sex, years of education, global cognition, vascular risk factors, APOE4 genotype, residual sensorimotor symptoms from previous stroke and brain volume. RESULTS: There was a significant positive global linear association between DTC and hyperintensity burden (adjusted Wilks' λ = .87, = .01). Amongst all WMH volumes, hyperintensity burden from basal ganglia + thalamus provided the most significant contribution to the global association (adjusted β = .008, η = .03; = .04), independently of brain atrophy. CONCLUSIONS: In poststroke, increased DTC may be an indicator of larger white matter damages, specifically in subcortical regions, which can potentially affect the overall cognitive processing and decrease gait automaticity by increasing the cortical control over patients' locomotion.
背景:在执行心理任务时步态速度的急性变化[双重任务步态成本(DTC)],以及脑白质的磁共振成像高信号,都是有卒中病史的老年人重要的残疾预测指标。然而,在卒中后,DTC 是否与特定主要脑区的总体高信号容积相关,目前仍不清楚。 方法:这是一项队列研究,共纳入了 123 名来自安大略省神经退行性疾病研究倡议的老年(69±7 岁)卒中病史患者。对参与者进行临床评估,并在单任务和双重任务条件下评估步态表现。对结构神经影像学数据进行分析,以测量脑白质高信号(WMH)和正常表现体积。额、顶、枕和颞叶的 WMH 体积百分比以及基底节+丘脑的皮质下高信号是主要结局。多元模型在调整年龄、性别、受教育年限、整体认知、血管危险因素、APOE4 基因型、既往卒中的残留感觉运动症状和脑容量后,调查了 DTC 与高信号容积之间的关联。 结果:DTC 与高信号负荷之间存在显著的正线性关联(调整后的 Wilks' λ=.87,P=.01)。在所有 WMH 容积中,基底节+丘脑的高信号负荷对总体关联的贡献最大(调整后的 β=.008,η²=.03;P=.04),独立于脑萎缩。 结论:在卒中后,DTC 的增加可能是脑白质损伤更大的指标,特别是在皮质下区域,这可能通过增加对患者运动的皮质控制,影响整体认知处理并降低步态的自动性。
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