The relation between total cerebral small vessel disease burden and gait impairment in patients with minor stroke

Loos, Caroline; McHutchison, Caroline; Cvoro, Vera; Makin, Stephen; Staals, Julie; Chappell, Francesca M; Dennis, Martin; Oostenbrugge, Robert J. van

doi:10.1177/1747493017730780

Cited by 21 publications

(13 citation statements)

References 25 publications

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“…We recruited patients representative of the range of SVD features present in patients with typical lacunar or minor cortical ischaemic stroke to ensure relevance to patients that are commonly affected by SVD. (31, 32) Confirming that vascular function changes in SVD are not confined to one stroke type increases the generalisability of our findings. Stroke type and SVD imaging features were carefully assessed by experienced specialists using standardised, validated image processing and analysis techniques.…”

Section: Discussionsupporting

confidence: 79%

Intracranial functional haemodynamic relationships in patients with cerebral small vessel disease

Blair

Thrippleton

Shi

et al. 2019

Preprint

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BackgroundCerebral small vessel disease (SVD) is a major cause of stroke and dementia. The underlying cerebrovascular dysfunction is poorly understood. We investigated cerebrovascular reactivity, blood flow, vascular and cerebrospinal fluid (CSF) pulsatility, and their independent relationship to SVD features, in patients with minor ischaemic stroke and MRI evidence of SVD.MethodsWe recruited patients with minor ischaemic stroke and assessed CVR using Blood Oxygen Level Dependent (BOLD) MRI during a hypercapnic challenge, cerebral blood flow, vascular and CSF pulsatility using phase contrast MRI, and structural MR brain imaging to quantify white matter hyperintensities (WMH) and perivascular spaces (PVS). We quantified CVR in seven white matter and six subcortical grey matter regions, measured blood flow in carotid and vertebral arteries, intracranial venous sinuses, internal jugular veins and CSF flow at the aqueduct and foramen magnum. We used multiple regression to identify SVD features, blood flow and pulsatility parameters associated with CVR, controlling for patient characteristics.ResultsIn 53 of 60 patients with complete data (age 68.0±8.8, 74% male, 75% hypertensive), CVR in grey and white matter decreased with increasing blood pressure (BP, respectively −0.001%/mmHg, p=0.01 and −0.006%/mmHg, p=0.01, per mmHg increase in BP). After controlling for age, gender and systolic BP, white matter CVR decreased with increasing WMF volume (−0.01%/mmHg per log10 increase in WMH volume, p=0.02) and basal ganglia PVS (−0.01%/mmHg per point increase in PVS score, p=0.02). White matter CVR decreased with increasing venous pulsatility (superior sagittal sinus −0.03%/mmHg, p=0.02, per unit increase in pulsatility index) but not with cerebral blood flow (p=0.58). Lower foramen magnum CSF stroke volume was associated with worse white matter CVR (0.04%/mmHg per ml increase in stroke volume, p=0.04) and increased basal ganglia PVS.ConclusionsContemporaneous assessment of CVR, intracranial vascular and CSF pulsatility demonstrates important interrelationships of these vascular functions in humans. Decreased CVR, increased venous pulsatility and reduced foramen magnum CSF stroke volume suggests that dynamic vascular dysfunctions underpin PVS dysfunction and WMH development. Improved understanding of microvascular dysfunction and CSF dynamics offers new intervention targets to reduce SVD lesion development and their impact on cognitive dysfunction and stroke.

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Section: Discussionsupporting

confidence: 79%

Intracranial functional haemodynamic relationships in patients with cerebral small vessel disease

Blair

Thrippleton

Shi

et al. 2019

Preprint

Self Cite

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“…We recruited patients representative of the range of SVD features present in patients with typical lacunar or minor cortical ischemic stroke to ensure relevance to patients who are commonly affected by SVD. 33,34 Confirming that vascular function changes in SVD are not confined to 1 stroke type increases the generalizability of our findings. Stroke type and SVD imaging features were carefully assessed by experienced specialists using standardized, validated image processing and analysis techniques.…”

Section: Discussionsupporting

confidence: 74%

Intracranial hemodynamic relationships in patients with cerebral small vessel disease

et al. 2020

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ObjectiveTo investigate cerebrovascular reactivity (CVR), blood flow, vascular and CSF pulsatility, and their independent relationship with cerebral small vessel disease (SVD) features in patients with minor ischemic stroke and MRI evidence of SVD.MethodsWe recruited patients with minor ischemic stroke and assessed CVR using blood oxygen level–dependent MRI during a hypercapnic challenge, cerebral blood flow (CBF), vascular and CSF pulsatility using phase-contrast MRI, and structural magnetic resonance brain imaging to quantify white matter hyperintensities (WMHs) and perivascular spaces (PVSs). We used multiple regression to identify parameters associated with SVD features, controlling for patient characteristics.ResultsFifty-three of 60 patients completed the study with a full data set (age 68.0% ± 8.8 years, 74% male, 75% hypertensive). After controlling for age, sex, and systolic blood pressure, lower white matter CVR was associated with higher WMH volume (−0.01%/mm Hg per log10 increase in WMH volume, p = 0.02), basal ganglia PVS (−0.01%/mm Hg per point increase in the PVS score, p = 0.02), and higher venous pulsatility (superior sagittal sinus −0.03%/mm Hg, p = 0.02, per unit increase in the pulsatility index) but not with CBF (p = 0.58). Lower foramen magnum CSF stroke volume was associated with worse white matter CVR (0.04%/mm Hg per mL increase in stroke volume, p = 0.04) and more severe basal ganglia PVS (p = 0.09).ConclusionsLower CVR, higher venous pulsatility, and lower foramen magnum CSF stroke volume indicate that dynamic vascular dysfunctions underpin PVS dysfunction and WMH development. Further exploration of microvascular dysfunction and CSF dynamics may uncover new mechanisms and intervention targets to reduce SVD lesion development, cognitive decline, and stroke.

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“…Some previous studies have demonstrated that WMH [5][6][7][8][9], lacunes [8,10] and CMBs [11] were associated with gait disturbance, but other studies found that lacunes [5,7,9], CMBs [5,7,9] and PVS [7,9] were not associated with motor performance. Moreover, most investigations have focused primarily on general gait function by using semiquantitative clinical rating scales, chair-stand time or gait velocity for gait measurement [5,7,9,10,12], which may not be sufficiently sensitive to detect early changes in gait performance of elderly people with unrecognized CSVD. In addition, recent studies have demonstrated that the total CSVD burden might better capture the overall effect of CSVD on cognitive function [13,14], but the relationship between total CSVD burden and gait pattern in independently living elderly people is still unknown.…”

Section: Introductionmentioning

confidence: 99%

Cerebral small vessel disease is associated with gait disturbance among community-dwelling elderly individuals: the Taizhou imaging study

Wang

Jiang

et al. 2020

Aging

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Gait disturbance is considered to be a significant clinical manifestation of cerebral small vessel disease (CSVD). We aimed to investigate the association between different imaging markers of CSVD or total CSVD burden and gait disturbance in a community-dwelling population. In the cross-sectional Taizhou Imaging Study (TIS), 314 participants free of neurological disorders underwent MRI scanning and gait assessment with quantitative wearable devices as well as clinical rating scales. In linear regression, after adjustment for demographics and vascular risks, total CSVD burden was associated with prolonged 3-m walking (β=0.118, P=0.035), shorter stride length (β=-0.106, P=0.042), and poorer Timed-Up-and-Go (TUG) performance (β=0.146, P=0.009). Lacunes were positively associated with 3-m walking (β=0.118, P=0.037) and duration of TUG test (β=0.112, P=0.047). White matter hyperintensities and cerebral microbleeds were associated with prolonged stride time (β=0.134, P=0.024) and increased stance phase time percentage (β=0.115, P=0.038), respectively. Logistic regression revealed that participants with high CSVD burden or more lacunes were more likely to have an impaired gait velocity and an impaired TUG test. These results suggest that total CSVD burden and CSVD imaging markers are associated with gait disturbance among community-dwelling elderly people. Different CSVD imaging markers may cause gait disturbance through different pathways.

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The relation between total cerebral small vessel disease burden and gait impairment in patients with minor stroke

Cited by 21 publications

References 25 publications

Intracranial functional haemodynamic relationships in patients with cerebral small vessel disease

Intracranial functional haemodynamic relationships in patients with cerebral small vessel disease

Intracranial hemodynamic relationships in patients with cerebral small vessel disease

Cerebral small vessel disease is associated with gait disturbance among community-dwelling elderly individuals: the Taizhou imaging study

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