脑小血管病患者双重任务行走步态参数的研究

Gait parameters during dual task walking in patients with cerebral small vessel disease

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。

Objective To analyze the changes in gait parameters during single task walking(STW)and dual task walking(DTW)in elderly patients with cerebral small vessel disease(CSVD),and to explore the correlation between imaging markers of CSVD and gait parameters.Methods A total of 42 CSVD patients admitted in Department of Neurology of the Seventh Medical Center of Chinese PLA General Hospital from September 1,2020 to June 1,2021 were enrolled in this study.Based on the total score of CSVD,they were assigned into high-(n=16),moderate-(n=16)and low-burden(n=10)groups.Cerebral lacunar infarction(LI)and cerebral microbleeds(CMB)was observed with MRI scanning,and the severity of white matter hyperintensity(WMH)was assessed with Fazeka scoring system.A series of gait parameters were examined,including speed,cadence,stride length and stride time of STW and DTW(cognitive workload during a walking task)to calculate dual task cost(DTC).Results There were significant differences in velocity,cadence,stride length and time among the 3 groups(P<0.05,P<0.01).DTW gait parameters were obviously worse than those of STW,with declined speed,cadence and stride length,and longer stride time(P<0.01).In the correlation analysis,the velocity(r=-0.316,P=0.041)and stride length(r=-0.309,P=0.046)of STW were correlated with the total score of CSVD.During DTW,velocity(r=-0.629,P=0.000),cadence(r=-0.474,P=0.001),stride length(r=-0.393,P=0.010)and stride time(r=0.482,P=0.001)were correlated with the total score.For DTC,total score of CSVD,WMH and LI were correlated with speed,cadence and stride time(P<0.05,P<0.01).Conclusion DTW is more sensitive and comprehensive than STW to find the changes of gait parameters in CSVD patients.Total score of CSVD shows better value in predicting gait changes than single imaging marker,with stronger correlation.