Correlation between gait impairment, cognitive impairment, and neuroimaging features in patients with cerebral small vessel disease

doi:10.3877/cma.j.issn.1673-9248.2025.03.005

Abstract

Abstract:

Objective

To investigate the correlations between gait impairment, cognitive impairment, and neuroimaging features in patients with cerebral small vessel disease (CSVD).

Methods

A total of 140 patients diagnosed with CSVD by neuroimaging examinations at the Department of Neurology, the Third Hospital of Hebei Medical University from April to November 2023 were retrospectively and consecutively enrolled. CSVD burden was quantified using established imaging markers (white matter hyperintensity, lacunes, cerebral microbleeds, enlarged perivascular spaces) and summed into a total score (range: 0-4). Participants were stratified by burden severity: mild (0-1, n=61) and severe (2-4, n=79). Based on the montreal cognitive assessment (MoCA) score, patients were divided into the cognitive-impaired group (0-25 points, n=105) and the cognitive-impaired group (26-30 points, n=35). Univariate analysis (t-test and χ² test) was used to compare differences in clinical and imaging data between different groups. Multiple linear regression analysis was applied to investigate the associations between CSVD total burden and gait/cognitive impairment. Multivariate logistic regression was used to identify independent influencing factors for cognitive impairment. Receiver operating characteristic (ROC) curve analysis was employed to evaluate diagnostic performance of key predictors.

Results

Compared to the mild-burden patients the severe-burden patients exhibited significantly slower gait speed [(0.34±0.12) m/s vs (0.47±0.11) m/s, t=6.166, P<0.001], reduced stride length [(0.39±0.13) m vs (0.45±0.10) m, t=3.054, P=0.003], lower Tinetti performance-oriented mobility assessment (POMA) score [(20.90±4.42) vs (23.95±2.44), t=4.849, P<0.001], and worse MoCA score [(20.46±5.07) vs (24.43±4.04), t=5.013, P<0.001]. Conversely, they had significantly wider stride width [(0.16±0.06) m vs (0.13±0.06) m, t=-2.950, P=0.004] longer and timed up and go (TUG) test time [(17.84±9.10) s vs (12.69±4.06) s, t=-4.115, P<0.001]. Multiple linear regression analysis showed that after adjusting for age, activities of daily living (ADL) score, and hypertension, CSVD total burden was negatively correlated with gait speed, stride length, Tinetti POMA score, and MoCA score, and positively correlated with stride width and TUG time (all P<0.05). Compared with the cognitively normal group, the cognitive impairment group had significantly higher age [(67.00±8.83) years vs (63.34±8.38) years, t=-2.149, P=0.033], homocysteine levels [(18.02±10.52) μmol/L vs (14.13±6.45) μmol/L, t=-2.017, P=0.046], proportions of moderate-to-severe white matter hyperintensity (67.6% vs 28.6%, χ²=16.415, P<0.001), proportions of cerebral microbleeds (44.8% vs 14.3%, χ²=10.443, P=0.001), and CSVD total burden score [(2.21±1.17) vs (1.23±1.09), t=4.382, P<0.001]. They also had significantly lower gait speed [(0.37±0.13) m/s vs (0.48±0.10) m/s, t=4.627, P<0.001]. Multivariate logistic regression analysis showed that after adjusting for confounding factors such as age and homocysteine levels, severe CSVD total burden (OR=1.714, 95%CI: 1.074-2.736, P<0.05) and decreased gait speed (OR=0.954, 95%CI: 0.914-0.995, P<0.05) remained significantly associated with cognitive impairment. ROC curve analysis showed that the combination of CSVD total burden and gait speed had the highest predictive efficacy for cognitive impairment in CSVD patients, with an area under the curve (AUC) of 0.779 (95%CI: 0.695-0.863).

Conclusion

Severe CSVD burden leads to gait and cognitive impairment in CSVD patients, increasing fall risk. Integrating neuroimaging burden quantification with gait speed assessment provides a clinically viable strategy for early identification of cognitive impairment in CSVD patients.

Key words: Cerebral small vessel disease, Total burden, Gait impairment, Cognitive impairment

Wanhu Liu, Wei Bu, Yujuan Dong, Wenjun Li, Yanan Jia, Cuicui Liu, Huiling Ren. Correlation between gait impairment, cognitive impairment, and neuroimaging features in patients with cerebral small vessel disease[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2025, 19(03): 198-206.

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Figures/Tables 8

项目	轻度CSVD总负荷组（n=61）	重度CSVD总负荷组（n=79）	统计值	P值
男性[例（%）]	35（57.4）	49（62.0）	χ²=0.310	0.578
年龄（岁， $x ¯ ± s$ ）	64.33±8.02	67.44±9.23	t=2.094	0.038
体质量指数（kg/m²， $x ¯ ± s$ ）	25.34±3.41	25.07±2.75	t=-0.469	0.640
ADL评分（分， $x ¯ ± s$ ）	90.50±13.36	83.42±17.68	t=-2.591	0.011
吸烟[例（%）]	21（34.4）	29（36.7）	χ²=0.113	0.737
饮酒[例（%）]	20（32.8）	16（20.3）	χ²=2.687	0.101
既往史
高血压病[例（%）]	44（72.1）	69（87.3）	χ²=5.116	0.024
糖尿病[例（%）]	21（34.4）	24（26.6）	χ²=0.258	0.611
冠心病[例（%）]	12（19.7）	20（25.3）	χ²=0.622	0.430
既往卒中[例（%）]	27（44.3）	30（38.0）	χ²=0.564	0.453
实验室检查
总胆固醇（mmol/L， $x ¯ ± s$ ）	4.54±0.95	4.30±1.14	t=-1.324	0.188
甘油三酯（mmol/L， $x ¯ ± s$ ）	1.76±1.10	1.54±0.89	t=-1.279	0.203
高密度脂蛋白胆固醇（mmol/L， $x ¯ ± s$ ）	1.21±0.27	1.13±0.22	t=-1.861	0.065
低密度脂蛋白胆固醇（mmol/L， $x ¯ ± s$ ）	2.73±0.79	2.50±0.88	t=-1.536	0.127
空腹血糖（mmol/L， $x ¯ ± s$ ）	6.97±3.12	6.55±2.72	t=-0.850	0.397
同型半胱氨酸（μmol/L， $x ¯ ± s$ ）	16.78±9.25	17.07±10.10	t=0.160	0.873
影像学资料
lacune[例（%）]	8（13.1）	62（78.5）	χ²=58.830	<0.001
CMB[例（%）]	6（9.8）	46（58.2）	χ²=34.526	<0.001
基底节区中重度EPVS[例（%）]	15（26.2）	57（70.9）	χ²=31.172	<0.001
中重度WMH[例（%）]	19（31.1）	62（78.5）	χ²=31.629	<0.001

项目	轻度CSVD总负荷组（n=61）	重度CSVD总负荷组（n=79）	统计值	P值
男性[例（%）]	35（57.4）	49（62.0）	χ²=0.310	0.578
年龄（岁， $x ¯ ± s$ ）	64.33±8.02	67.44±9.23	t=2.094	0.038
体质量指数（kg/m²， $x ¯ ± s$ ）	25.34±3.41	25.07±2.75	t=-0.469	0.640
ADL评分（分， $x ¯ ± s$ ）	90.50±13.36	83.42±17.68	t=-2.591	0.011
吸烟[例（%）]	21（34.4）	29（36.7）	χ²=0.113	0.737
饮酒[例（%）]	20（32.8）	16（20.3）	χ²=2.687	0.101
既往史
高血压病[例（%）]	44（72.1）	69（87.3）	χ²=5.116	0.024
糖尿病[例（%）]	21（34.4）	24（26.6）	χ²=0.258	0.611
冠心病[例（%）]	12（19.7）	20（25.3）	χ²=0.622	0.430
既往卒中[例（%）]	27（44.3）	30（38.0）	χ²=0.564	0.453
实验室检查
总胆固醇（mmol/L， $x ¯ ± s$ ）	4.54±0.95	4.30±1.14	t=-1.324	0.188
甘油三酯（mmol/L， $x ¯ ± s$ ）	1.76±1.10	1.54±0.89	t=-1.279	0.203
高密度脂蛋白胆固醇（mmol/L， $x ¯ ± s$ ）	1.21±0.27	1.13±0.22	t=-1.861	0.065
低密度脂蛋白胆固醇（mmol/L， $x ¯ ± s$ ）	2.73±0.79	2.50±0.88	t=-1.536	0.127
空腹血糖（mmol/L， $x ¯ ± s$ ）	6.97±3.12	6.55±2.72	t=-0.850	0.397
同型半胱氨酸（μmol/L， $x ¯ ± s$ ）	16.78±9.25	17.07±10.10	t=0.160	0.873
影像学资料
lacune[例（%）]	8（13.1）	62（78.5）	χ²=58.830	<0.001
CMB[例（%）]	6（9.8）	46（58.2）	χ²=34.526	<0.001
基底节区中重度EPVS[例（%）]	15（26.2）	57（70.9）	χ²=31.172	<0.001
中重度WMH[例（%）]	19（31.1）	62（78.5）	χ²=31.629	<0.001

项目	轻度CSVD总负荷组（n=61）	重度CSVD总负荷组（n=79）	t值	P值
步速（m/s）	0.47±0.11	0.34±0.12	6.166	<0.001
步长（m）	0.45±0.10	0.39±0.13	3.054	0.003
步宽（m）	0.13±0.06	0.16±0.06	-2.950	0.004
TUG（s）	12.69±4.06	17.84±9.10	-4.115	<0.001
Tinetti POMA（分）	23.95±2.44	20.90±4.42	4.849	<0.001
MoCA（分）	24.43±4.04	20.46±5.07	5.013	<0.001

项目	模型1		模型2
项目	β值	P值	β值	P值
步速	-4.886	<0.001	-4.770	<0.001
步长	-2.624	0.002	-2.466	0.005
步宽	14.137	0.001	12.640	0.003
TUG	1.669	0.001	1.599	0.003
Tinetti POMA	-1.100	<0.001	-1.041	<0.001
MoCA	-1.690	<0.001	-1.697	<0.001

项目	认知障碍组（n=105）	认知正常组（n=35）	统计值	P值
男性[例（%）]	65（61.9）	19（54.3）	χ²=0.635	0.426
年龄（岁， $x ¯ ± s$ ）	67.00±8.83	63.34±8.38	t=-2.149	0.033
体质量指数（kg/m²， $x ¯ ± s$ ）	25.27±3.07	24.97±3.04	t=-0.456	0.649
ADL评分（分， $x ¯ ± s$ ）	85.67±16.89	88.97±14.24	t=1.028	0.306
吸烟[例（%）]	38（36.1）	12（35.4）	χ²=0.058	0.810
饮酒[例（%）]	26（36.2）	10（28.6）	χ²=0.174	0.677
既往史
高血压病[例（%）]	87（82.9）	26（74.3）	χ²=1.239	0.226
糖尿病[例（%）]	31（29.5）	14（40.0）	χ²=1.321	0.250
冠心病[例（%）]	26（24.8）	6（17.1）	χ²=0.864	0.353
既往卒中[例（%）]	43（41.0）	14（40.0）	χ²=0.010	0.921
实验室检查
总胆固醇（mmol/L， $x ¯ ± s$ ）	4.34±1.10	4.59±0.96	t=1.185	0.238
甘油三酯（mmol/L， $x ¯ ± s$ ）	1.57±0.91	1.85±1.18	t=1.469	0.144
高密度脂蛋白胆固醇（mmol/L， $x ¯ ± s$ ）	1.16±0.25	1.16±0.23	t=-0.071	0.944
低密度脂蛋白胆固醇（mmol/L， $x ¯ ± s$ ）	2.55±0.87	2.77±0.76	t=1.304	0.195
空腹血糖（mmol/L， $x ¯ ± s$ ）	6.78±3.15	6.59±2.02	t=-0.330	0.742
同型半胱氨酸（μmol/L， $x ¯ ± s$ ）	18.02±10.52	14.13±6.45	t=-2.017	0.046
影像学资料
lacune[例（%）]	55（52.4）	15（42.8）	χ²=0.952	0.329
CMB[例（%）]	47（44.8）	5（14.3）	χ²=10.443	0.001
基底节区中重度EPVS[例（%）]	59（56.2）	13（37.1）	χ²=3.813	0.051
中重度WMH[例（%）]	71（67.6）	10（28.6）	χ²=16.415	<0.001
CSVD总负荷（分， $x ¯ ± s$ ）	2.21±1.17	1.23±1.09	t=4.382	<0.001
步态参数
步速（m/s， $x ¯ ± s$ ）	0.37±0.13	0.48±0.10	t=-4.627	<0.001
步长（m， $x ¯ ± s$ ）	0.40±0.13	0.45±0.10	t=-1.877	0.063
步宽（m， $x ¯ ± s$ ）	0.15±0.06	0.14±0.06	t=-1.092	0.277

项目	认知障碍组（n=105）	认知正常组（n=35）	统计值	P值
男性[例（%）]	65（61.9）	19（54.3）	χ²=0.635	0.426
年龄（岁， $x ¯ ± s$ ）	67.00±8.83	63.34±8.38	t=-2.149	0.033
体质量指数（kg/m²， $x ¯ ± s$ ）	25.27±3.07	24.97±3.04	t=-0.456	0.649
ADL评分（分， $x ¯ ± s$ ）	85.67±16.89	88.97±14.24	t=1.028	0.306
吸烟[例（%）]	38（36.1）	12（35.4）	χ²=0.058	0.810
饮酒[例（%）]	26（36.2）	10（28.6）	χ²=0.174	0.677
既往史
高血压病[例（%）]	87（82.9）	26（74.3）	χ²=1.239	0.226
糖尿病[例（%）]	31（29.5）	14（40.0）	χ²=1.321	0.250
冠心病[例（%）]	26（24.8）	6（17.1）	χ²=0.864	0.353
既往卒中[例（%）]	43（41.0）	14（40.0）	χ²=0.010	0.921
实验室检查
总胆固醇（mmol/L， $x ¯ ± s$ ）	4.34±1.10	4.59±0.96	t=1.185	0.238
甘油三酯（mmol/L， $x ¯ ± s$ ）	1.57±0.91	1.85±1.18	t=1.469	0.144
高密度脂蛋白胆固醇（mmol/L， $x ¯ ± s$ ）	1.16±0.25	1.16±0.23	t=-0.071	0.944
低密度脂蛋白胆固醇（mmol/L， $x ¯ ± s$ ）	2.55±0.87	2.77±0.76	t=1.304	0.195
空腹血糖（mmol/L， $x ¯ ± s$ ）	6.78±3.15	6.59±2.02	t=-0.330	0.742
同型半胱氨酸（μmol/L， $x ¯ ± s$ ）	18.02±10.52	14.13±6.45	t=-2.017	0.046
影像学资料
lacune[例（%）]	55（52.4）	15（42.8）	χ²=0.952	0.329
CMB[例（%）]	47（44.8）	5（14.3）	χ²=10.443	0.001
基底节区中重度EPVS[例（%）]	59（56.2）	13（37.1）	χ²=3.813	0.051
中重度WMH[例（%）]	71（67.6）	10（28.6）	χ²=16.415	<0.001
CSVD总负荷（分， $x ¯ ± s$ ）	2.21±1.17	1.23±1.09	t=4.382	<0.001
步态参数
步速（m/s， $x ¯ ± s$ ）	0.37±0.13	0.48±0.10	t=-4.627	<0.001
步长（m， $x ¯ ± s$ ）	0.40±0.13	0.45±0.10	t=-1.877	0.063
步宽（m， $x ¯ ± s$ ）	0.15±0.06	0.14±0.06	t=-1.092	0.277

因素	偏回归系数	标准误	Wald值	P值	OR值	95%CI
年龄	0.046	0.028	2.704	0.100	1.047	0.991~1.106
HCY	0.059	0.034	2.985	0.084	1.060	0.992~1.133
步速	-0.048	0.022	4.805	0.028	0.954	0.914~0.995
CSVD总负荷	0.539	0.239	5.100	0.024	1.714	1.074~2.736

指标	曲线下面积	敏感度	特异度	约登指数	最佳截断值
步速	0.738	0.886	0.514	0.40	0.377
CSVD总负荷	0.727	0.895	0.429	0.324	2.000
步速+CSVD总负荷	0.779	0.667	0.829	0.496	0.760

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