Cerebral White Matter Changes (Leukoaraiosis), Stroke, and Gait Disturbance

Abstract

In our Veteran population, leukoaraiosis is an independent predictor of gait disturbance after accounting for stroke and cerebral atrophy. Although leukoaraiosis is a form of cerebrovascular disease, it appears to be most closely associated to gait disturbance in the absence of symptomatic stroke or leg deficit.

Advanced Coronary Artery Calcification and Cerebral Small Vessel Diseases in the Healthy Elderly

“…Similarly, cerebral SVD are closely related to the development of future stroke, cognitive impairment, or antithrombotic-related fatal complications in the brain. WML is associated with information processing speed and executive function deficits, 23-25 gait disturbance in the elderly, 26 the risk of ischemic and hemorrhagic stroke, 27-29 and anticoagulation-related cerebral 37 CAC is considered a part of subclinical atherosclerosis and the development of CAC is also related to cardiovascular risk factors. 1, 38 Recent progress has further elucidated associations between CAC and the development of atherosclerosis in other vascular beds, such as hypertensive retinopathy, carotid intima-media thickness, peripheral artery disease and early stage nephropathy.…”

Impact of White Matter Lesions on Physical Functioning and Fall Risk in Older People

“…All studies found an association between mobility impairment and overall increased WML volumes as well as increased regional WML volumes in periventricular, frontal, parietaloccipital, and frontal periventricular areas. 8,19,23,32,35 Two studies also reported a threshold effect of WMLs on mobility 7,31 with larger volumes of WMLs at baseline found to predict greater declines in mobility over time in longitudinal studies. 27,28,30,38 Finally, it has been reported that a significant increase in WML volumes occurs more frequently in mobility impaired people compared with people without such impairment.…”

“…First, the integrity of the neural network within the brain (ie, the corticostriate fibers or thalamostriatal fibers. 31,43 ) and the long descending motor fibers (ie, corticospinal fibers) are crucial in lower extremity motor control, 28 especially in relation to the selection and initiation of movement, direction of movement, and speed and duration of movement. Second, disruption in the frontalsubcortical circuits that interconnect various cortical areas is likely to compromise cognitive performance.…”

“…Greater volumes of WMLs, especially in the periventricular regions, were associated with decreased gait speed, shorter step length, increased double support time, and slowed gait initiation in cross-sectional studies. 8,16,[21][22][23]31 Two large longitudinal studies with follow-up periods of 8 and 13 years, respectively, found that individuals with severe periventricular WMLs show a more progressive decline in walking speed. 23,26 Four cross-sectional 7,14,16,23 and 2 longitudinal studies 23,26 have also reported nonsignificant associations between deep WMLs and gait performance, supporting the notion of different functional consequences of periventricular and deep WMLs.…”

White Matter Lesion Severity in Mild Acute Ischemic Stroke Patients and Functional Outcome After 1 Year

“…1,2 Leukoaraiosis, or white matter disease (WMD), can be detected as abnormal hypointensities on computed tomography and hyperintesities on T2-weighted or fluid-attenuated inversion recovery magnetic resonance imaging (MRI). 3 A common finding in the elderly, 4,5 WMD has been shown to associate with recurrent stroke, 6,7 cognitive decline, [8][9][10] gait disturbances, 11,12 hemorrhagic transformation, 13 and functional outcome after ischemic stroke. [14][15][16][17] Most studies have examined the relationship between functional stroke outcome and WMD severity using either computed tomography visual scales 14,18,19 or volumetric measurements.…”