Gait disorders patients with patients with cerebral microangiopathy: association with the microstructural integrity of the tracts involved in walking

Abstract

Objective. To assess the impaired ambulation and the fall risk in patients with cerebral microangiopathy (CMA), and their association with the microstructural integrity of the tracts involved in walking. Material and methods. One hundred twenty-four patients with CMA (STRIVE, 2013) and hyperintensity of white matter at the Fazekas stage 2—3 (mean age 62.2±7.9), and 30 healthy volunteers of the control group (mean age 59.8±6.4) underwent a comprehensive assessment of walking using the Tinetti tests, the 6-meter walk test, and the clinical scale of the impaired ambulation severity. Based on the diffusion MRI data, 80 patients with CMA and 21 healthy volunteers of the control group were assessed for fractional anisotropy (FA) in the frontopontine, corticoreticulospinal, and pontocerebellar tracts using a segmentation method. Results. 68.5% of CMA patients showed impaired ambulation, and 41.9% had a moderate and high fall risk. FA, reflecting overall microstructural integrity, in the frontopontine and corticoreticulospinal tracts correlated with the results of the Tinetti test («balance» subscale and total score) and consistently decreased as the severity of impaired ambulation and the fall risk increased. For the most significant sections of the tracts (60—80, 80—95), ROC analysis obtained threshold FA values associated with the development of mild impaired ambulation and moderate fall risk, with high sensitivity and specificity (AUC>0.75). Conclusion. Impaired ambulation and associated fall risk are common in patients with CMA. Microstructural damage (assessed by FA) of the frontopontine and corticoreticulospinal tracts, mainly at the level of subcortical and deep white matter, is crucial for the development of impaired ambulation and fall risk. The obtained FA threshold values of these tracts can be used as objective markers to identify patients at high risk of impaired ambulation and fall risk in the early stages, which is essential for timely prevention.

Affiliated Institutions

• Research Center of Neurology RU
• Moscow State University TJ
• Lomonosov Moscow State University RU

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