Gait in Elderly With Cerebral Small Vessel Disease

Laat, Karlijn F. de; Norden, Anouk G.W. van; Gons, Rob A.R.; Oudheusden, Lucas J.B. van; Uden, Ingeborg W.M. van; Bloem, Bastiaan R.; Zwiers, Marcel P.; Leeuw, Frank‐Erik de

doi:10.1161/strokeaha.110.583229

Cited by 124 publications

(123 citation statements)

References 26 publications

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“…Subclinical infarcts, also called silent infarcts, are more clinically significant than the name would imply, as they can have effects on functional and clinical outcomes. 3,4,6,24 In exploratory analyses in the subsample for whom we could calculate the HOMA index, we found that leisure time physical activity is associated with fewer silent infarcts even after adjusting for insulin resistance. Engaging in physical activity may be an important strategy to reduce the prevalence of SBI and thus, potentially, improve functional outcomes.…”

Section: Mrimentioning

confidence: 84%

Lower prevalence of silent brain infarcts in the physically active

Willey

Moon²,

Paik³

et al. 2011

Neurology

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Objective: To examine the independent association between physical activity and subclinical cerebrovascular disease as measured by silent brain infarcts (SBI) and white matter hyperintensity volume (WMHV). Methods:The Northern Manhattan Study (NOMAS) is a population-based prospective cohort examining risk factors for incident vascular disease, and a subsample underwent brain MRI. Our primary outcomes were SBI and WMHV. Baseline measures of leisure-time physical activity were collected in person. Physical activity was categorized by quartiles of the metabolic equivalent (MET) score. We used logistic regression models to examine the associations between physical activity and SBI, and linear regression to examine the association with WMHV.Results: There were 1,238 clinically stroke-free participants (mean age 70 Ϯ 9 years) of whom 60% were women, 65% were Hispanic, and 43% reported no physical activity. A total of 197 (16%) participants had SBI. In fully adjusted models, compared to those who did not engage in physical activity, those in the upper quartile of MET scores were almost half as likely to have SBI (adjusted odds ratio 0.6, 95% confidence interval 0.4-0.9). Physical activity was not associated with WMHV. Conclusions:Increased levels of physical activity were associated with a lower risk of SBI but not WMHV. Engaging in moderate to heavy physical activities may be an important component of prevention strategies aimed at reducing subclinical brain infarcts. Neurology ® 2011;76:2112-2118 GLOSSARY BMI ϭ body mass index; CI ϭ confidence interval; HOMA ϭ homeostatic model assessment; MET ϭ metabolic equivalent; NOMAS ϭ Northern Manhattan Study; OR ϭ odds ratio; SBI ϭ silent brain infarcts; SCVD ϭ subclinical cerebrovascular disease; WMH ϭ white matter hyperintensity; WMHV ϭ white matter hyperintensity volume.Subclinical cerebrovascular disease (SCVD), as manifested by subclinical brain infarcts (SBI) or white matter hyperintensities (WMH) visualized on MRI, is common in the elderly. SCVD has significant public health impact as it has been associated with impaired mobility and falls, 1,2 cognitive dysfunction and dementia, 3,4 and incident ischemic stroke. 5Many of the risk factors for clinically apparent ischemic stroke are also associated with SCVD.2,6 Physical activity is a component of the guidelines for ideal cardiovascular health, which advise at least 150 minutes per week of moderate intensity, or 75 minutes of vigorous intensity activity. 7 Physical activity has been associated with a lower risk of ischemic stroke in the Northern Manhattan Study (NOMAS) and others independently of other vascular disease risk factors. 8,9 There has been little literature on the association between physical activity and SCVD, 10,11 and few studies have included Hispanics. The purpose of this study is to examine the independent association between measures of physical activity and SCVD. We hypothee-Pub ahead of print on June 8, 2011, at www.neurology.org. From the Departments of Neurology (J.Z.W., Y.P.M., M.S.V.E...

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Section: Mrimentioning

confidence: 84%

Lower prevalence of silent brain infarcts in the physically active

Willey

Moon²,

Paik³

et al. 2011

Neurology

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“…Murray et al (2004) found that functional decline was specifically associated with the presence of gait disorders and bradykinesia, but not with other MPS such as rigidity or tremor. Similarly, neuroimaging studies reveal that white matter lesions in the frontal and parietal lobes were linked to bradykinesia (de Laat et al 2012) and gait disturbances (de Laat et al 2010), suggesting a shared pathway between bradykinesia and gait in aging.…”

Section: Introductionmentioning

confidence: 97%

Contributions of mild parkinsonian signs to gait performance in the elderly

Allali

Mahoney

2014

AGE

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Mild parkinsonian signs (MPS) and gait abnormalities are common in aging, but the association between MPS and objective gait measures is not established in the elderly. This study aims to identify the link between MPS and quantitative gait measures, as well as to determine the pathogenesis of MPS in nondemented community-dwelling older adults without idiopathic Parkinson's disease or other parkinsonian syndromes. Three hundred seventy-four non-demented older adults (mean age, 76.44±6.71 years, 57 % women) participated in this study, where comprehensive neurological and medical assessments were conducted. We defined MPS based on the presence of any one of bradykinesia, rigidity, or rest tremor. Velocity and spatial, temporal, and variability gait parameters were recorded using an instrumented walkway. The associations of MPS and gait parameters as well as the relationship of individual MPS with medical illnesses were assessed with linear regressions controlling for key covariates. Participants with MPS walked slower and with disturbed spatial and variability components of gait compared to those without MPS. Bradykinesia was associated with worse spatial and variability gait parameters. This association was only significant for axial bradykinesia, but not for the presence of bradykinesia in the limbs. Cerebrovascular disease (β=.20, p<.01) was associated with bradykinesia, whereas cardiovascular disease (β=.15, p<.05) was associated with rigidity. Among MPS, bradykinesia but not rigidity or tremor was associated with worse quantitative gait performance in older adults. Cerebrovascular disease, a preventable condition, was specifically associated with bradykinesia.

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“…The primary gait outcomes were gait velocity and stride length, which correlate with disease severity in these patients [74]. The primary balance outcome was recovery of stance in the retropulsion test, with postural instability being a feature of small vessel disease and a common cause of falls in these patients [75].…”

Section: The Use Of Tdcs In Patients With Small Vessel Disease With Gmentioning

confidence: 99%

“…This may represent a large placebo effect in a patient who may not have felt confident to walk to his maximum capability before the stimulation. Alternatively, the effect size may reflect the nature of the subcortical stroke-gait function in patients with subcortical white matter disease can be more variable [74], perhaps relating to fluctuating attentional drive directed towards walking.…”

Section: The Use Of Tdcs In Patients With Gait Disturbance Following mentioning

confidence: 99%

Treatments for Neurological Gait and Balance Disturbance: The Use of Noninvasive Electrical Brain Stimulation

Kaski

Bronstein

2014

Advances in Neuroscience

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Neurological gait disorders are a common cause of falls, morbidity, and mortality, particularly amongst the elderly. Neurological gait and balance impairment has, however, proved notoriously difficult to treat. The following review discusses some of the first experiments to modulate gait and balance in healthy adults using anodal transcranial direct current stimulation (tDCS) by stimulating both cerebral hemispheres simultaneously. We review and discuss published data using this novel tDCS approach, in combination with physical therapy, to treat locomotor and balance disorders in patients with small vessel disease (leukoaraiosis) and Parkinson’s disease. Finally, we review the use of bihemispheric anodal tDCS to treat gait impairment in patients with stroke in the subacute phase. The findings of these studies suggest that noninvasive electrical stimulation techniques may be a useful adjunct to physical therapy in patients with neurological gait disorders, but further mutlicentre randomized sham-controlled studies are needed to evaluate whether experimental tDCS use can translate into mainstream clinical practice for the treatment of neurological gait disorders.

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Gait in Elderly With Cerebral Small Vessel Disease

Cited by 124 publications

References 26 publications

Lower prevalence of silent brain infarcts in the physically active

Lower prevalence of silent brain infarcts in the physically active

Contributions of mild parkinsonian signs to gait performance in the elderly

Treatments for Neurological Gait and Balance Disturbance: The Use of Noninvasive Electrical Brain Stimulation

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