Relationship Between Gray Matter Changes And Gait Disorders In Patients With Cerebral Small Vessel Disease

Objective To investigate the relationship between the gray matter volume alteration and gait disorder in patients with cerebral small vessel disease（CSVD）.Methods Thirty six CSVD patients in the outpatient department of Neurology of our hospital from July 2020 to June 2021 were selected,and 30 healthy controls（HC）matched with age,gender and education were selected.A comprehensive neuropsychological assessment was carried out for each subject using the MMSE,Mo CA,and CAMCOG-C.The gait was recorded and analyzed by the Energy Expenditure Activity Meter（IDEEA）;the brain imaging data of the subjects were collected by MRI imaging technology,and the changes of the gray matter volume of the CSVD patients were analyzed by VBM;the linear regression analysis was used To investigate the relationship between gait function and gray matter volume in CSVD patients.Results There was no statistical difference in age,education,gender and vascular risk factors（hypertension,diabetes,hyperlipidemia）between the two groups（P > 0.05）.The cognitive assessment scores of CSVD group were lower than those of HC group,with differences in MOCA,MMSE,and CAMCOG-C（P < 0.001）.The imaging data of CSVD group showed more pathological features in WMH（P = 0.001）,Li（P =0.030）and CMB（P = 0.011）.Compared with the HC group,CSVD patients had longer stride time（Z =-2.309,P = 0.020）,longer step time（Z =-2.300,P =0.021）,and shorter step size（T =-2.129,P = 0.037）,decreased pace（T =-3.323,P = 0.001）,and decreased cadence（Z =-3.078,P = 0.002）.Gait variability analysis showed that CSVD group has Stronger step length variability（T =-1.375,P = 0.018）.The left cerebellum,orbital inferior frontal gyrus,and left lingual gyrus gray matter volume in the CSVD group were significantly lower than those in the HC group.Further correlation analysis found that the orbital inferior frontal gyrus was significantly related to language（R = 0.396,P = 0.017）and computing（R = 0.467,P = 0.004）in the CSVD group.Left lingual gyrus was related to language（R = 0.359,P =0.032）,memory（R = 0.368,P = 0.027）,execution（R = 0.394,P = 0.018）,calculation（R = 0.455,P = 0.005）in the CSVD group.The lingual gray matter volume was positively related to stride speed in the CSVD group（R = 0.382,P = 0.022）;the lingual gray matter volume in the HC group was negatively correlated with swing time（R =-0.468,P = 0.009）.Whole brain regression analysis found that the correlation strength between gait parameters and caudate nucleus in CSVD group was significantly higher than that in HC group.Conclusion CSVD patients have gait disturbance,and this gait disturbance is related to the reduction of gray matter volume in motor-related brain regions.The body may compensate by enhancing the association between gait and caudate nucleus in CSVD disease state.