The Effect Of Imaging Features Of Cerebral Small Vessel Disease On Gait And Balance In Patients With Minor Stroke

Objective:To investigate the effects of individual imaging markers and total burden of cerebral small vessel disease(CSVD)on gait and balance impairment in patients with minor stroke,and to lay a theoretical foundation for the prevention and treatment of gait and balance dysfunction in patients with minor stroke.Methods:Patients with minor stroke who were hospitalized in the Department of Neurology of the Affiliated Hospital of Qingdao University between January 2021 and January 2022 were included,and demographic data(age,sex)and vascular risk factors(hypertension,diabetes,hyperlipidemia,history of smoking,and history of drinking)were collected on admission.The infarct characteristics and CSVD were assessed by cranial magnetic resonance imaging(MRI)after admission,and white matter hyperintensities(WMH),enlarged perivascular spaces(EPVS),cerebral microbleeds(CMB),and lacunes were scored using the standards for reporting vascular changes on neuroimaging(STRIVE).WMH can be divided into periventricular white matter hyperintensities(PVWMH)and deep white matter hyperintensities(DWMH).And the "total CSVD score" was applied to indicate the total CSVD MRI burden of patients.Gait speed was assessed by the 6-m walk speed test,and an objective assessment of dynamic balance of the trunk was obtained by the timed-up-and-go(TUG)test.Statistical processing was performed using R studio(3.6.1).Pearson correlation test and Spearman correlation test were used to assess the correlation between demographic data,vascular risk factors,National Institutes of Health Stroke Scale(NIHSS)score,infarct sites,and CSVD and walking speed and balance.And variables in the CSVD(including individual markers and total burden)that were significantly associated with gait and balance were subjected to linear regression analysis.Then,variables(except CSVD)that were statistically significant in the above correlation analysis were extracted as variables to be controlled for multiple hierarchy regression analysis to assess the independent influence power of individual radiographic markers and the total burden of CSVD.The statistical significance level was set to 0.05.Results:A total of 273 patients were enrolled during the study,including 170 men(62%)and 103 women(38%);age averaged 63.3 ± 9.2 years;gait speed averaged 1.02 ± 0.21 m/s,and TUG averaged 13.44 ± 3.44 s.The results are as follows.(1)Univariate correlation analysis of clinical data and CSVD scores with gait and balance tests:Gait speed was significantly slower in elderly,female,and smoking patients,but only older age was associated with longer TUG duration.Stroke severity(NIHSS score)was not related to gait speed or length of TUG test time.Infarcts at the basal ganglia and radial coronary sites were associated with slower gait speed and longer TUG test duration.Subjects with higher PVWMH scores,DWMH scores,and total CSVD burden had slower gait speed.Subjects with higher PVWMH scores spent more time on the TUG test.(2)Univariate linear regression analysis of CSVD radiographic markers and total burden with gait and balance:PVWMH scores,DWMH scores,and the total CSVD burden significantly influenced gait speed.PVWMH scores influenced dynamic balance.(3)Multiple hierarchical linear regression model statistical analysis:Confounding factors such as demographics,vascular risk factors,infarct location,and NIHSS were included,and PVWMH,DWMH,and CSVD total burden were included as coexisting impact factors in the model.The results showed that PVWMH were independent impact factors of gait speed and TUG test in patients with minor stroke.Conclusions:CSVD is associated with gait and balance disorders after a minor stroke.PVWMH are independent impact factors of gait and balance disorders in patients with minor stroke.Therefore,the development of prevention strategies for the progression of WMH in clinical work may provide useful help in the prevention and treatment of gait and balance dysfunction in patients with minor stroke.