BACKGROUND:This study aims to explore the correlation between body composition, encompassing factors such as muscle mass and fat distribution, and gait performance during both single-task walking (STW) and dual-task walking (DTW) in patients diagnosed with cerebral small vessel disease (CSVD). METHODS:The data of hospitalized patients diagnosed with CSVD, including cadence, stride time, velocity and stride length, as well as information on variability, asymmetry and coordination during both STW and DTW, were assessed. The number of falls reported by each participant was also assessed. RESULTS:A total of 95 CSVD patients were assessed, and the results showed that individuals with low appendicular skeletal muscle mass (ASM), which includes both the low ASM group and the combination of low ASM and high body fat (BF) group, had reduced velocity or cadence, shortened stride length, and prolonged stride time across all walking modalities compared to the control group. Only the combination of the low ASM and high BF group exhibited a deterioration in the coefficient of variation (CV) for all basic parameters and the Phase Coordination Index (PCI) compared to the control group across all walking patterns. Conversely, patients in the high BF group displayed a decline in basic parameters, primarily during cognitive DTW. Concurrently, the high BF group showed a significant increase in the CV and the PCI compared to the control group only during cognitive DTW. Furthermore, regardless of gender, both ASM and BF independently correlated with the occurrence of falls. CONCLUSIONS:CSVD patients with varying body compositions could allocate different levels of attention to their daily walking routines.

Objective:To compare the gait characteristics of cognitive and motor dual task walking (DTW) in patients with cerebral small vessel disease (CSVD), and determine the best gait parameters to diagnose CSVD and judge the severity of the disease.Methods:A total of 106 patients with CSVD and 21 healthy individuals were included from September 1, 2020 to July 1, 2021 in the Seventh Medical Center of Chinese People′s Liberation Army General Hospital. According to the Fazekas scores, the subjects were divided into mild ( n=34, 1 point), moderate ( n=34, 2 points), severe ( n=38,3 points) groups and control group ( n=21). Participants were recorded parameters under single task walking (STW) and DTW conditions, and calculated dual task effect (DTC) through the difference between single task and dual task. The differences in gait variances and their DTC were shown by generalized estimation equations when performed in STW and DTW and 4 groups of the severity of disease. Post-hoc comparisons were corrected using Bonferroni′s method. Spearman analyses were applied to explore the correlations between gait parameters and their DTC during STW or DTW and severity of disease. Based on the Logistic model, combining predictors or probabilities were gained and applied to establish receiver operating characteristic curve in order to calculate sensitivity, specificity, and the area under the curve. Results:In the control group, there was no statistically significant difference in gait parameters between STW and DTW. In the CSVD group, the gait parameters of STW were significantly better than cognitive or motor DTW (all P<0.05). In the control group, there was no statistically significant difference in basic gait parameters under different tasks (all P>0.05). In cognitive DTW, temporal gait parameters (stride frequency and stride time) deteriorated significantly only in moderate and severe groups [stride frequency:moderate group 100.220±1.795/min,severe group 94.525±2.139/min;stride time:moderate group (1.227±0.024) s, severe group (1.299±0.031) s], but spatial parameters [stride length: control group (1.050±0.021) m, mild group (0.974±0.022) m, moderate group (0.903±0.025) m, severe group (0.793±0.026) m; stride speed: control group (0.944±0.028) m/s, mild group (0.866±0.030) m/s, moderate group (0.751±0.027) m/s, severe group (0.606±0.022) m/s] were significantly different among all groups (except the control group and mild group;all P<0.05). The DTC of all gait parameters during cognitive DTW was higher than that during motor DTW (all P<0.05) for CSVD patients. While no any difference was found between cognitive DTW and motor DTW in the control group (all P>0.05). Similarly, the temporal parameters′ DTC of cognitive DTW was abnormal only in the late stage of disease, while the spatial parameters′ DTC showed statistically significant difference among all the groups (including the control group and the mild group;all P<0.05). Correlation coefficients of the spatial parameters and their DTC in condition of cognitive DTW were significantly higher than temporal parameters and their DTC (0.50< r<0.64 vs 0.15< r<0.39). The area under curve of the combined predictor was significantly higher than that of any single index. Conclusions:Cognitive DTW can better reflect the abnormal gait of CSVD patients. The spatial parameters and DTC of cognitive DTW could effectively diagnose CSVD and distinguish the disease of severity. And DTC might be better indicators. For diagnosis of CSVD, there was no significant discrepancy between the spatial parameters and DTC, but the combined predictor could significantly improve the sensitivity and reduce the false negative rate.

The goal of the current study was to demonstrate if the rest-activity rhythm (RAR) was altered in apathetic older adults with cerebral small vessel disease (CSVD) and find out the relationship between apathy/depression severity and RAR features in CSVD patients. This is a cross-sectional observational investigation including 53 CSVD cases (54.74% men), aged 70.70 ± 6.18 years old. The participants were assessed by neuropsychiatric inventory (NPI) subscale of apathy (NPI-apathy) and depression (NPI-depression) in succession, according to updated diagnostic criteria for apathy (DCA). Each subject wore an actigraph device (ActiGraph GT3X) in their nondominant hand for 7 days to collect raw data. Using a non-parametric methodological analysis, this study determined RAR variables such as interdaily stability (IS), intraday variability (IV) and relative amplitude (RA). Patients in the apathy-positive group had a higher Fazekas score than those in the apathy-negative group. IS, but not IV, RA, or objective sleep variables, differed between elderly patients with varying degrees of CSVD burden. Furthermore, apathy severity was statistically correlated with RA after adjusting for age, gender and education level, whereas depression severity was not associated with RAR variables. Finally, we discovered that the severity of apathy had no significant relationship with the severity of depression. All these findings indicated that the RAR altered in apathetic older adults with CSVD, and apathy was associated with decreased RAR amplitude.

Introduction:Gait impairment is a common symptom among individuals with cerebral small vessel disease (CSVD). However, performance differences between single-task walking (STW) and dual-task walking (DTW) among individuals with CSVD remain unclear. Therefore, we aimed to examine differences in gait characteristics during STW and DTW as well as the association between gait performance and neuroimaging markers.Methods:We enrolled 126 older individuals with CSVD. The speed, cadence, stride length, stride time, and their dual-task cost (DTC) or variability were measured under the STW, motor-cognitive DTW (cognitive DTW), and motor-motor DTW (motor DTW) conditions. We examined neuroimaging features such as white matter hyperintensities (WMHs), lacunes, microbleeds, and total burden. Further, we analysed the association of neuroimaging markers with gait performance, including gait variability and DTC.Results:Almost all spatiotemporal characteristics, as well as their DTCs or variabilities, showed significant among-group differences according to disease severity in the cognitive DTW condition; however, relatively lesser differences were observed in the STW and motor DTW conditions. The total CSVD burden score was moderately correlated with all the spatial parameters, as well as their DTCs or variabilities, in the cognitive DTW condition. Moreover, WMHs showed a correlation with speed, stride time, and cadence, as well as their DTCs, in the cognitive DTW condition. Furthermore, lacunes showed a moderate correlation with speed, stride length, and the DTC of speed, whilst microbleeds were only related to the DTC of stride length in the cognitive DTW condition. Neuroimaging biomarkers were not correlated with spatiotemporal parameters in STW and motor DTW conditions after Bonferroni correction. Moreover, the correlation coefficient between the total CSVD burden score and gait parameters was greater than those of other biomarkers.Discussion:Parameters in the cognitive DTW condition are more appropriate than those in the motor DTW condition for the evaluation of gait abnormalities in patients with CSVD. Moreover, the total CSVD burden score might have better predictive utility than any single neuroimaging marker. Patients with CSVD, especially those with moderate-to-severe disease, should concentrate more on their gait patterns and reduce the load of secondary cognitive tasks whilst walking in daily life.

目的 分析老年脑小血管病(cerebral small vessel disease,CSVD)患者单任务行走(STW)和双重任务行走(DTW)步态参数变化,探讨影像学标志物与步态参数的相关性.方法 选择解放军总医院第七医学中心神经内科2020年9月1日～2021年6月1日连续就诊的42例CSVD患者,依据CSVD总评分分为高负荷组16例、中负荷组16例和低负荷组10例.行头颅MRI检查,记录腔隙性脑梗死(LI)和脑微出血(CMB),根据Fazekas量表评分评估脑白质高信号(WMH).行STW和运动-认知的DTW,记录步速、步频、步长及跨步时间,计算双重任务效应(DTC).结果 3组DTW时步速、步长、步频和跨步时间比较,差异有统计学意义(P<0.05,P<0.01).与STW比较,DTW时步速、步频、步长明显降低,跨步时间明显延长(P<0.01).STW时,CSVD总评分与步速(r=-0.316,P=0.041)、步长(r=-0.309,P=0.046)相关.DTW时,CSVD总评分与步速(r=-0.629,P=0.000)、步频(r=-0.474,P=0.001)、步长(r=-0.393,P=0.010)、跨步时间(r=0.482,P=0.001)相关.DTC时,CSVD总评分、WMH、LI与步速、步频及跨步时间相关(P<0.05,P<0.01).结论 DTW较STW可更敏感、更全面发现CSVD患者步态参数的变化;CSVD总评分较单独使用某一项影像学标志物可更好预测患者步态的变化,且相关性更强.

目的 研究脑小血管病患者影像学标志物与跌倒风险之间的关系.方法 纳入2020年9月至2021年12月在解放军总医院第七医学中心神经内科住院的脑小血管病患者142例,分为有跌倒风险组58例和无跌倒风险组84例.所有患者行影像学标志物分析,包括脑白质高信号、腔隙性脑梗死、脑微出血,采用唐顿跌倒风险指数(DFRI)进行跌倒风险评估,DFRI≥3分为有跌倒风险.采用logistic回归分析法研究DFRI与神经影像标志物的相关性.结果 有跌倒风险组与无跌倒风险组年龄、性别、受教育年限、心绞痛、心肌梗死、糖尿病以及偏头痛比较,差异无统计学意义(P>0.05).有跌倒风险组高血压、高脂血症、中重度脑白质高信号比例明显高于无跌倒风险组(82.8％vs 48.8％,84.5％vs 56.0％,75.9％vs 41.7％,P<0.01).2组脑小血管病总负荷评分比较,差异有统计学意义(P<0.01).2组脑微出血和腔隙性脑梗死比例比较,差异无统计学意义(P>0.05).校正高血压、高脂血症等有意义的混杂因素后,中重度脑白质高信号是DFRI升高的危险因素(OR=4.136,95％CI:1.299～13.169,P=0.016).结论 对于脑小血管病患者而言,脑白质高信号的严重程度更能预测患者的跌倒风险.

目的 探究脑小血管病(CSVD)患者淡漠症状及其与体动分析设备在昼间和夜间采集数据的相关性.方法 选择2021年11月至2022年4月解放军总医院第七医学中心神经内科住院的老年CSVD患者56例,根据神经精神问卷淡漠分量表评分分为淡漠组21例,非淡漠组35例.又根据CSVD负荷评分分为高负荷组40例(CSVD负荷评分≥2分)和低负荷组16例(CSVD负荷评分≤1分).采用头颅MRI检查评定腔隙、脑白质高信号、脑微出血、扩大的血管周围间隙.体动分析设备佩戴于非惯用手,采集连续7 d的数据,得到昼间矢量和以及睡眠治疗参数.结果 与非淡漠组比较,淡漠组腔隙、脑微出血、Fazekas量表评分、CSVD负荷评分更高(P<0.05,P<0.01).与低负荷组比较,高负荷组表现出更低的昼间矢量和[(885.97±410.04)次vs(1369.27±411.28)次,P<0.01].淡漠严重程度与昼间矢量和(r=-0.811,P=0.000)及卧床总时间(r=-0.349,P=0.030)呈负相关.结论 体动分析是CSVD患者淡漠严重程度的理想方法.

目的 分析老年脑小血管病(CSVD)患者,运动认知风险综合征(MCRS)的患病率及运动和认知功能减退情况.方法 选择解放军总医院第七医学中心神经内科2018年6月1日至2020年8月1日收治的130例60～80岁的CSVD患者(其中46例诊断MCRS综合征).对入组患者进行了词语流畅性(VFT)、画钟测试(CDT)、简易智力状态检查(MMSE)等认知功能测试、单任务行走(STW)和双任务行走(DTW),并计算双重任务效应(DTC).单因素分析两组患者的一般临床资料及运动认知结果,将P<0.05的因素纳入多因素Logistic回归分析中,分析CSVD患者发生MCRS的相关危险因素.同时单因素分析了脑白质病变不同负荷间运动和认知结果的差异.结果 本研究中老年CSVD患者MCRS的发病率约36.92％(48/130).MCRS阴性组部分认知功能显著优于MCRS阳性组,VFT[(17.695±4.069)比(16.083±3.319)]分和MMSE[28(28.29)比27(26,27)]分.运动方面,与MCRS阴性组比较,MCRS阳性组的DTW速度[(90.500±21.138)比(65.417±17.301)]mm/s,DTC[12.425(5.845,18.985)比16.190(9.605,22.925)]％均有显著差异.Logistic回归发现VFT(OR=1.876,95％CI 1.329～2.648,P<0.01)、DTC(OR=0.900,95％CI 0.823～0.985,P=0.022)、DWT速度(OR=0.869,95％CI 0.809～0.933P<0.01)及MMSE(OR=0.055,95％CI 0.017～0.175,P<0.01)是MCRS的独立危险因素.在调整了年龄、性别、教育程度和共存疾病等相关危险因素后,VFT(OR=1.961,95％CI 1.276～3.014,P=0.002)、DTW速度(OR=0.861,95％CI 0.767～0.966,P<0.01)及MMSE(OR=0.032,95％CI 0.007～0.146,P<0.01)、DTC(OR=0.861,95％CI 0.767～0.966,P<0.01)仍是独立危险因素.结论 本研究中老年CSVD患者中,MCRS阳性患者认知及运动功能表现显著劣于MCRS阴性者,VFT、MMSE、DTW步行速度是MCRS发生的相关影响因素,患者在DTW下更易出现步态障碍,主要表现为行走速度的明显减低.

目的 分析脑小血管病(CSVD)患者运动认知风险综合征(MCRS)的步态参数及步态模式变化.方法 选择2020年9月1日至2021年6月1日在解放军总医院第七医学中心神经内科连续就诊的42例伴有脑白质病变的CSVD患者为研究对象,根据是否诊断为MCRS分为MCRS阳性组(n=24)和MCRS阴性组(n=18).比较两组患者的简易智力状态检查(MMSE)、Fazekas评分,并比较患者单任务行走(STW)和双重任务行走(DTW)时的速度、步频、步长、跨步时间,计算双重任务效应(DTC)及步行率.采用二元Logistic回归分析CSVD患者发生MCRS的独立危险因素.结果 MCRS阴性组患者MMSE评分[28(27,30)分比26(26,27)分]、DTW步行率[9.046(8.775,9.582)(cm·min)/步比8.230(7.232,8.878)(cm·min)/步]、DTW速度[(93.611±19.560)cm/s比(82.167±16.531)cm/s]高于MCRS阳性组,差异有统计学意义(P<0.05).二元Logistic回归显示,DTW步行率(OR=0.422,95％CI:0.182～0.978,P=0.044)、MMSE评分(OR=0.276,95％CI:0.099～0.764,P=0.013)是CSVD患者发生MCRS的独立危险因素.调整一般资料后,DTW步行率(OR=0.286,95％CI:0.089～0.920,P=0.036)、MMSE评分(OR=0.193,95％CI:0.045～0.816,P=0.022)仍是CSVD患者发生MCRS的独立危险因素.42例患者执行STW时的速度[(91.595±19.251)cm/s比(87.071±18.569)cm/s]、步长[(98.214±14.447)cm比(93.524±12.968)cm]高于DTW,差异有统计学意义(P<0.01),效应值为中等效应(Cohen's d=0.239、0.342).结论 CSVD患者在进行DTW时更易出现步态障碍,主要表现为行走速度和步长的减小以及步态模式的改变.步行率是发生MCRS的独立危险因素,随着DTW步行率的增加,发生MCRS的风险增加.

目的 通过数字化书写及绘画任务,探讨脑白质高信号(WMH)患者是否存在特征性上肢运动障碍.方法 选择2020年4月至2021年4月在解放军总医院第七医学中心神经内科住院的82例WMH患者为研究对象,根据Fazekas评分对患者的WMH程度进行分组,分为低负荷组(n=42)、中负荷组(n=20)、高负荷组(n=20).使用WACOM触控屏及电子笔进行书写及绘画测试,采用MovAlyzeR软件对运动学参数进行记录和处理.比较3组患者签名时的速度、压力、平均曲折度;书写"正"字第3、4笔的压力、速度;书写"永"字的垂直大小及水平大小;绘画阿基米德螺旋时的平均标准化急动度(ANJ)及子运动和,分析WMH不同程度与书写及绘画参数的差异.采用Spearman相关分析患者WMH程度与书写、绘画参数之间的相关性.结果 低负荷、中负荷、高负荷组患者签名平均曲折度、签名速度、书写"正"字第4笔速度比较[0.2(0.1,0.4)比0.3(0.2,0.4)比0.4(0.2,0.6)、1.6(1.4,2.3)cm/s比1.5(1.2,2.0)cm/s比1.2(1.1,1.6)cm/s、1.4(1.2,1.8)cm/s比1.3(0.9,1.7)cm/s比0.9(0.8,1.4)cm/s],差异有统计学意义(Z=9.571、10.726、12.478;P<0.01);书写"永"字的垂直大小比较[(1611.3±405.0)cm比(1474.1±512.8)cm比(1286.8±470.1)cm],差异有统计学意义(F=3.580,P<0.05);描绘阿基米德螺旋时的ANJ、子运动和比较[30.9(22.2,51.3)比44.6(23.2,80.8)比52.8(31.2,100.8)、8.0(2.5,11.5)个比11.0(5.0,17.0)个比12.0(9.3,15.8)个],差异有统计学意义(Z=7.636、7.792;P<0.05).相关性分析显示,WMH程度与签名平均曲折度、螺旋ANJ、螺旋子运动和呈正相关(r=0.366、0.301、0.300;P<0.01),与签名速度、书写"正"字第4笔速度、"永"字垂直大小呈负相关(r=-0.307、-0.307、-0.287;P<0.01).结论 随脑白质病变严重程度的增加,患者书写及绘画显著恶化,且书写障碍主要存在于垂直方向.

Background Apathy is attracting more and more attention in clinical practice. As one of the most common features of cerebral small vessel disease (CSVD), the assessment of apathy still mainly relies on observers. With the development of Information and Communication Technologies (ICTs), new objective tools take part in the early detection of apathy. Objectives To detect apathy in patients with CSVD and find out the relationship between apathy and actigraphic data sampled from the diurnal and nocturnal periods. Methods A total of 56 patients with CSVD were recruited for a cross-sectional observational study. Apathy was diagnosed by the diagnostic criteria for apathy in neurocognitive disorders. The presence of lacunes, white matter hyperintensities, cerebral microbleeds (CMBs), and perivascular spaces (PVS) in magnetic resonance imaging (MRI) images were rated independently. Actigraph devices were worn in the non-dominant hands of each subject for 7 consecutive days to collect samples of raw data, and diurnal vector magnitude (VM) and a series of sleep quality variables were obtained. Results We found that the frequency of apathy in Chinese patients with CSVD reached 37.50%. Patients in the Apathy+ group showed more lacunes and CMBs, and higher Fazekas scores in comparison to apathy-group individuals. Diurnal VM, instead of other sleep quality variables, was lower in CSVD patients with apathy relative to those without apathy. Lastly, we discovered that diurnal VM and total time in bed (TTB) correlated negatively with apathy severity in patients with CSVD. Conclusion Actigraphy is a promising choice to evaluate apathy in patients with CSVD.