The relationship between white matter hyperintensity and gait in patients with cerebral small vessel disease

Recent studies have explored the link between white matter hyperintensity (WMH) and gait disorders; however, inconsistent results have arisen due to varied populations and sample sizes. We aimed to examine the relationship between WMH severity and gait in patients with cerebral small vessel disease (CSVD).

We included 335 patients with CSVD with independent walking ability hospitalized at the Department of Neurology, Tianjin Huanhu Hospital, from August 1, 2018, to May 17, 2021. WMH was graded using the Fazekas scale on magnetic resonance imaging. Patients were categorized into the mild and moderate-to-severe WMH groups. A wearable gait analysis system was employed to evaluate the impact of WMH severity on patients' walking ability.

Patients in the moderate-to-severe WMH group exhibited slower gait speed, shorter length stride, and reduced foot strike and toe-off angles compared to those in the mild WMH group, all with significant differences (p < 0.05). Analysis of gait parameter symmetry and variability showed significant increases in the moderate-to-severe WMH group. Multivariate logistic regression analysis identified toe-off angle, swing phase coefficient of variation, and age as independent risk factors for WMH-induced gait impairment.

The severity of white matter lesions affects the gait of patients with small vessel disease, including spatiotemporal and kinematic parameters, symmetry, and variability. With increasing age, the severity of white matter lesions increases, resulting in a reduced toe-off angle and greater swing variability, leading to decreased stability.