Clinical Research On Gait Disturbance In Patients With Cerebral Small Vessel Disease

Objective:To analyze the gait characteristics of dual task walking(DTW)in Cerebral Small Vessel Disease(CSVD)patients with with Motoric Cognitive Risk Syndrome(MCRS).Method:A total of 158 patients with white matter damage who were treated in hospital from July 2019 to July 2021 were selected.According to the diagnostic criteria of Motoric Cognitive Risk Syndrome,they were divided into MCRS group(69 cases)and Non-MCRS group(89 cases),and the patients with cerebral small vessel disease were divided into mild group,moderate group and severe group according to the overall burden quartile method.The portable gait analyzer IDEEA(product of MiniSun LLC,USA)was used to conduct single-task walking test and dual-task walking test(cognitive+motor dual task,motor+motor dual task),analyzed and compared the gait parameters of each group,including stride frequency,stride speed,stride length,stride swing time,dual task cost(DTC).Results:There was no significant difference in the baseline data between the MCRS group and the NonMCRS group in terms of gender,age,height,weight,education level,hypertension,diabetes,and the coronary heart disease cases(all P>0.05),and the results were comparable.The prevalence of Lacunar infarction(65.2%VS 69.7%),peripheral vascular space(60.9%VS 67.4%),white matter lesions(82.6%VS 82.0%),cerebral microbleeds(36.2%VS 25.8%)in MCRS group and non-MCRS group were no significant difference(P>0.05),excepted the overall burden score(2.54±1.05 VS 2.07±0.97)(P<0.05).In the MCRS group and the non-MCRS,the MCRS group had lower stride speed,lower stride frequency,shorter stride length,and longer swing time during the single-task walking,cognitive-motor dual-task walking,and motor-motor dual-task walking(P<0.05).Compared with the non-MCRS group,the stride speed DTC,stride frequency DTC,stride length DTC and swing time DTC of the the MCRS group did not change significantly during the motor-motor dual-task walking(all P>0.05).However during the cognitive-motor dual-task walking,the MCRS group has higher stride frequency DTC,stride length DTC and swing time DTC.The patients of MCRS group were divided into the mild group,moderate group and severe group,the gait parameters of stride speed,stride frequency,stride length and swing time were no significant difference in the three walking modes(STW,DTW1,DTW2).(all P>0.05).Compared with single task walking,in the MCRS group,the DTW stride speed decreased the stride frequency decreased,the stride length was shortened,and the swing time was prolonged,especially during the cognitive-motor dual-task walking(P<0.05).This change is not obvious in the mild group,in the middle,and the severe group is more obvious.Conclusion:MCRS patients had more obvious gait disturbance in the dual-task walking,tended to slow gait,short stride length,and decreased gait stability.Dual-task walking was more able to detect less observable gait changes than the single-task walking alone,and further reflected the activities of daily living in patients with MCRS.Objective:To analyze the walk ratio(WR)for both genders in a general population of older adults with Cerebral Small Vessel Disease(CSVD)across different speeds and conditions.Method:A total of 114 patients with white matter damage,including 71 males and 43 females,who were treated in the hospital from July 2019 to July 2021 were selected.The portable gait analyzer IDEEA(MiniSun LLC,USA)was used in the single walking and DTW test.single walking,DTW test and different speed walking tasks,recording gait parameters under seven different conditions(normal walking speed,cognitive+motor dual task,motor+motor dual task,slow speed,very-slow speed,fast speed,very-fast speed),including walking speed(cm/s)、step length(cm)and step frequency(steps/min),walk ratio(WR=step length/step frequency)was calculated.Results:A total of 114 patients with cerebral small vessel disease were selected(mean age,66.5 years(SD=7.17),27.3%were female),with an average height of 166.4cm(SD=7.47),an average weight of 70.0Kg(SD=12.04),and an average BMI of 25.2(SD=3.48),the he average years of education was 10.1 years(SD=3.3 7),and the prevalence rates of hypertension,diabetes,and coronary heart disease were 70.2%,30.7%,and 13.2%,respectively.The prevalence rates of lacunar infarction,perivascular space,white matter lesions,and cerebral microbleeds were 59.6%,36.8%,46.5%,and 14.0%,respectively.The average walking speed of patients with cerebral small vessel disease under different conditions was 63.4-119.3 cm/s,the step frequency was 97.8-121.5 step/min,the step length was 44.2-54.6 cm,and the WR was 0.45-0.51 cm/step/min.WR at preferred speed was 0.47 cm/step/min(SD=0.09),WR at cognitive+motor dual-task walking(STW1)was 0.49 cm/step/min(SD=0.10),motor+motor dual-task walking(STW2),the WR is 0.46cm/step/min(SD=0.07),the WR at a slightly slower speed is 0.48cm/step/min(SD=0.09),and the WR at an wery-slow speed is 0.51cm/step/min(SD=0.11),the WR at a slightly faster speed is 0.49cm/step/min(SD=0.10),and the WR at a very-fast speed is 0.45cm/step/min(SD=0.07).Compared with single-task(ie,preferred speed)walking,the WR of dual-task walking changed significantly,and the difference was statistically significant;WR was significantly increased at very-slow speed,and WR was significantly reduced at very-fast speed;There is no significant change in WR during a certain speed.In the preferred speed and fast walking speedy the WR of women was significantly lower than that of men,and there was no significant difference between the two groups in other walking conditions.Conclusion:WR remains unchanged within a certain speed range.However,WR changed markedly when walking speed was outside this range,for attention had to be divided between cognitive and motor tasks,the same as the dual-task conditions.Males and females had significant differences in WR under preferred speed and fast walking conditions,but no significant difference in WR under dual-tasking and slow walking.