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Cerebral small vessel disease, cardiovascular risk factors, and future walking speed in old age: a population-based
Emerald G Heiland1,2,3, Anna-Karin Welmer4,5,6,7, Grégoria Kalpouzos4
1Department of Surgical Sciences, Medical Epidemiology, Uppsala University, Dag Hammarskjölds väg 14B, 75 185, Uppsala, Sweden. emerald.heiland@surgsci.uu.se.
Insights
Cerebral small vessel disease (cSVD) markers, particularly white matter hyperintensities (WMH) and perivascular spaces (PVS), significantly predict future walking speed limitation in older adults. Managing cardiovascular risk factors may help preserve walking ability.
Area of Science:
- Neurology
- Geriatrics
- Public Health
Background:
- Cerebral small vessel disease (cSVD) is a common condition in older adults.
- cSVD markers, including white matter hyperintensities (WMH), lacunes, and perivascular spaces (PVS), are associated with various neurological deficits.
- The impact of cSVD on gait and mobility over time is an area of active research.
Purpose of the Study:
- To investigate the association between combined and individual cSVD markers and future walking speed over a 9-year period.
- To determine if cardiovascular risk factors (CRFs) modify these associations.
- To identify specific cSVD markers that are most predictive of walking speed decline.
Main Methods:
- Population-based cohort study of 331 adults aged ≥60 years with normal baseline walking speed.
- Assessment of cSVD markers (WMH, lacunes, PVS) using MRI at baseline.
- Calculation of a combined cSVD score and a cardiovascular risk factor score.
- Linear mixed-effects models and Cox proportional hazards models to analyze the association between cSVD markers and walking speed over 9 years.
Main Results:
- The highest tertile of combined cSVD markers was associated with a 3.78-fold increased risk of developing walking speed limitation.
- High WMH burden was linked to a faster decline in walking speed and increased risk of limitation (HR 2.78).
- High PVS burden also increased the risk of walking speed limitation (HR 2.13), while lacunes were significant only in men.
Conclusions:
- Combined cSVD markers are strong predictors of future walking speed limitation in healthy older adults, independent of cognitive function.
- WMH and PVS are the most significant contributors to walking speed decline.
- Improving cardiovascular health may be a key strategy to mitigate the adverse effects of cSVD on mobility.
Background:
The purpose of this study was to examine the associations between combined and individual cerebral small vessel disease (cSVD) markers on future walking speed over 9 years; and to explore whether these associations varied by the presence of cardiovascular risk factors (CRFs).
Methods:
This population-based cohort study included 331 adults, aged ≥60 years, without limitation in walking speed (≥0.8 m/s). At baseline, cSVD markers, including white matter hyperintensities (WMH), lacunes, and perivascular spaces (PVS), were assessed on magnetic resonance imaging. The modifiable CRFs (physical inactivity, heavy alcohol consumption, smoking, hypertension, high total cholesterol, diabetes, and overweight/obese) were combined into a score. The association between baseline cSVD markers and the decline in walking speed was examined using linear mixed-effects models, whereas Cox proportional hazards models were used to estimate the association with walking speed limitation (defined as < 0.8 m/s) over the follow-up.
Results:
Over the follow-up period, 76 (23.0%) persons developed walking speed limitation. Participants in the highest tertile of the combined cSVD marker score had a hazard ratio (HR) of 3.78 (95% confidence interval [CI] 1.70-8.45) for walking speed limitation compared with people in the lowest score tertile, even after adjusting for socio-demographics, CRFs, cognitive function, and chronic conditions. When investigating the cSVD markers individually, having the highest burden of WMH was associated with a significantly faster decline in walking speed (β coefficient - 0.020; 95% CI -0.035-0.004) and a greater HR of walking speed limitation (HR 2.78; 95% CI 1.31-5.89) compared with having the lowest WMH burden. Similar results were obtained for the highest tertile of PVS (HR 2.13; 95% CI 1.04-4.36). Lacunes were associated with walking speed limitation, but only in men. Having ≥4 CRFs and high WMH volume simultaneously, showed a greater risk of walking speed limitation compared with having ≥4 CRFs and low WMH burden. CRFs did not modify the associations between lacunes or PVS and walking speed.
Conclusions:
Combined cSVD markers strongly predict walking speed limitation in healthy older adults, independent of cognitive function, with WMH and PVS being the strongest contributors. Improving cardiovascular health may help to mitigate the negative effects of WMH on future walking speed.
