脑小血管病患者步态障碍、平衡障碍和跌倒研究进展
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摘要
脑小血管病是导致慢性脑组织低灌注的主要原因,而与脑白质病变相关的步态障碍、平衡障碍和跌倒可增加脑小血管病患者病残和病死风险。因此,了解步态障碍、平衡障碍和跌倒与脑白质病变之间的关联性、病理生理学机制、评价方法等相关研究进展,有助于预测跌倒的发生,并可针对其潜在风险采取相应干预措施,提高脑小血管病患者生活质量。
Cerebral small vessel disease(cSVD) is the leading cause of chronic cerebral hypoperfusion. Gait, balance disorders and falls associated with white matter lesions can increase the risk of sickness and death in patients with cSVD. Therefore, understanding the correlations between gait,balance disorders and falls and white matter lesions, pathophysiological mechanisms, evaluation methods,etc., can help to predict the occurrence of falls and can be taken against their potential risks.Corresponding interventions can improve the quality of life of patients with cSVD.
Cerebral small vessel disease(cSVD) is the leading cause of chronic cerebral hypoperfusion. Gait, balance disorders and falls associated with white matter lesions can increase the risk of sickness and death in patients with cSVD. Therefore, understanding the correlations between gait,balance disorders and falls and white matter lesions, pathophysiological mechanisms, evaluation methods,etc., can help to predict the occurrence of falls and can be taken against their potential risks.Corresponding interventions can improve the quality of life of patients with cSVD.
引文
[1] Teng Z, Dong Y, Zhang D, An J, Lv P. Cerebral small vessel disease and post-stroke cognitive impairment[J]. Int J Neurosci, 2017, 127:824-830.
[2] Forsberg KM, Zhang Y, Reiners J, Ander M, Niedermayer A,Fang L, Neugebauer H, Kassubek J, Katona I, Weis J, Ludolph AC, Del Tredici K, Braak H, Yilmazer-Hanke D. Endothelial damage, vascular bagging and remodeling of the microvascular bed in human microangiopathy with deep white matter lesions[J]. Acta Neuropathol Commun, 2018, 6:128-135.
[3] Pirker W, Katzenschlager R. Gait disorders in adults and the elderly:a clinical guide[J]. Wiener Klinische Wochenschrift,2017, 129:81-95.
[4] Kerber KA, Enrietto JA, Jacobson KM, Baloh RW.Disequilibrium in older people[J]. Neurology, 1998, 51:574-580.
[5] Bazner H, Oster M, Daffertshofer M, Hennerici M. Assessmentof gait in subcortical vascular encephalopathy by computerized analysis:a cross-sectional and longitudinal study[J]. J Neurol,2000, 247:841-849.
[6] Baloh RW, Ying SH, Jacobson KM. A longitudinal study of gait and balance dysfunction in normal older people[J]. Arch Neurol, 2003, 60:835-839.
[7] van der Holst HM, Tuladhar AM, Zerbi V, van Uden IW, de Laat KF, van Leijsen EM, Ghafoorian M, Platel B, Bergkamp MI, van Norden AG, Norris DG, van Dijk EJ, Kiliaan AJ, de Leeuw FE. White matter changes and gait decline in cerebral small vessel disease[J]. Neuroimage Clin, 2017, 17:731-738.
[8] Ter Telgte A, van Leijsen EM, Wiegertjes K, Klijn CJ, Tuladhar AM. de Leeuw FE. Cerebral small vessel disease:from a focal to a global perspective[J]. Nat Rev Neurol, 2018, 14:387-398.
[9] Rosano C. Kuller LH, Chung H, Arnold AM, Longstreth WT Jr,Newman AB. Subclinical brain magnetic resonance imaging abnormalities predict physical functional decline in highfunctioning older adults[J]. J Am Geriatr Soc, 2005, 53:649-654.
[10] Pinter D, Ritchie SJ, Gattringer T, Bastin ME, Hernández MD,Corley J, Maniega SM, Pattie A, Dickie DA, Gow AJ, Starr JM,Deary IJ, Enzinger C, Fazekas F, Wardlaw J. Predictors of gait speed and its change over three years in community-dwelling older people[J]. Aging(Albany NY), 2018, 10:144-153.
[11] de Laat KF, Tuladhar AM, van Norden AG, Norris DG, Zwiers MP, de Leeuw FE. Loss of white matter integrity is associated with gait disorders in cerebral small vessel disease[J]. Brain,2011, 134(Pt 1):73-83.
[12] de Laat KF, van Norden AG, Gons RA, van Oudheusden LJ,van Uden IW, Norris DG, Zwiers MP, de Leeuw FE. Diffusion tensor imaging and gait in elderly persons with cerebral small vessel disease[J]. Stroke, 2011, 42:373-379.
[13] Longstreth WT Jr, Manolio TA, Arnold A, Burke GL, Bryan N,Jungreis CA, Enright PL, O'Leary D, Fried L. Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people:the Cardiovascular Health Study[J]. Stroke, 1996, 27:1274-1279.
[14] Blahak C, Baezner H, Pantoni L, Poggesi A, Chabriat H,Erkinjuntti T, Fazekas F, Ferro JM, Langhorne P, O'Brien J,Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D,Hennerici MG; LADIS Study Group. Deep frontal and periventricular age related white matter changes but not basal ganglia and infratentorial hyperintensities are associated with falls:cross sectional results from the LADIS study[J]. J Neurol Neurosurg Psychiatry, 2009, 80:608-613.
[15] Doi T, Shimada H, Makizako H, Tsutsumimoto K, Hotta R,Nakakubo S, Suzuki T. Effects of white matter lesions on trunk stability during dual-task walking among older adults with mild cognitive impairment[J]. Age(Dordr), 2015, 37:120-127.
[16] Novak V, Haertle M, Zhao P, Hu K, Munshi M, Novak P,Abduljalil A, Alsop D. White matter hyperintensities and dynamics of postural control[J]. Magn Reson Imaging, 2009, 27:752-759.
[17] You H, Zhang H, Liu J, Han T, Zhang M, Zhao W, Jiang S.Effect of balance training with Pro-kin System on balance in patients with white matter lesions[J]. Medicine(Baltimore),2017, 96:E9057.
[18] Zheng JJ, Delbaere K, Close JC, Sachdev PS. Lord SR. Impact of white matter lesions on physical functioning and fall risk in older people:a systematic review[J]. Stroke, 2011, 42:2086-2090.
[19] Srikanth V, Beare R, Blizzard L, Phan T, Stapleton J, Chen J,Callisaya M, Martin K, Reutens D. Cerebral white matterlesions, gait, and the risk of incident falls:a prospective population-based study[J]. Stroke, 2009, 40:175-180.
[20] Corti MC, Baggio G, Sartori L, Barbato G, Manzato E,Musacchio E, Ferrucci L, Cardinali G, Donato D, Launer LJ,Zambon S, Crepaldi G, Guralnik JM. White matter lesions and the risk of incident hip fracture in older persons:results from the progetto veneto anziani study[J]. Arch Intern Med, 2007,167:1745-1751.
[21] Zheng JJ, Delbaere K, Close JC, Sachdev P, Wen W, Brodaty H, Lord SR. White matter hyperintensities are an independent predictor of physical decline in community-dwelling older people[J]. Gerontology, 2012, 58:398-406.
[22] Willey JZ, Moon YP, Dhamoon MS, Kulick ER, Bagci A,Alperin N, Cheung YK, Wright CB, Sacco RL, Elkind MS.Regional subclinical cerebrovascular disease is associated with balance in an elderly multi-ethnic population[J].Neuroepidemiology, 2018, 51(1/2):57-63.
[23] Zeng W, Liu F, Wang Q, Wang Y, Ma L, Zhang Y. Parkinson's disease classification using gait analysis via deterministic learning[J]. Neurosci Lett, 2016, 28:268-278.
[24] Hikosaka O, Kim HF, Yasuda M, Yamamoto S. Basal ganglia circuits for reward value-guided behavior[J]. Annu Rev Neurosci, 2014, 37:289-306.
[25] Fujino Y, Amimoto K, Sugimoto S, Fukata K, Inoue M, Uchino A, Takahashi H, Makita S. Relationship of white matter lesions and severity of pushing behavior after stroke[J]. J Phys Ther Sci, 2017, 29:2116-2120.
[26] Moscufo N, Wakefield DB, Meier DS, Cavallari M, Guttmann CR, White WB, Wolfson L. Longitudinal microstructural changes of cerebral white matter and their association with mobility performance in older persons[J]. PLoS One, 2018, 13:E0194051.
[27] Watanabe T, Saito K, Ishida K, Tanabe S, Nojima I. Auditory stimulus has a larger effect on anticipatory postural adjustments in older than young adults during choice step reaction[J]. Eur J Appl Physiol, 2017, 117:2409-2423.
[28] Lee YH, Song GG. Interventions to prevent falls in older adults[J]. JAMA, 2018, 319:1382-1389.
[29] Pantoni L, Basile AM, Pracucci G, Asplund K, Bogousslavsky J, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, O'brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D. Impact of age-related cerebral white matter changes on the transition to disability. The LADIS study:rationale, design and methodology[J]. Neuroepidemiology,2014, 24(1/2):51-62.
[30] Lauretani F, Ticinesi A, Gionti L, Prati B, Nouvenne A, Tana C, Meschi T, Maggio M. Short-Physical Performance Battery(SPPB)score is associated with falls in older outpatients[J].Aging Clin Expe Res, 2018.[Epub ahead of print]
[31] Ghanavati T, Smitt MS, Lord SR, Sachdev P, Wen W, Kochan NA, Brodaty H, Delbaere K. Deep white matter hyperintensities, microstructural integrity and dual task walking in older people[J]. Brain Imag Behav, 2018, 12:1488-1496.
[32] Auvinet B, Touzard C, Montestruc F, Delafond A, Goeb V. Gait disorders in the elderly and dual task gait analysis:a new approach for identifying motor phenotypes[J].J Neuroeng Rehabil, 2017, 14:7-15.
[33] Taylor ME, Lord SR, Delbaere K, Wen W, Jiang J, Brodaty H,Kurrle SE, Stefanie Mikolaizak A, Close JC. White matter hyperintensities are associated with falls in older people with dementia[J]. Brain Imaging Behav, 2018, 25:9943-9948.
[34] Ursin MH, Bergland A, Fure B, Thommessen B, Hagberg G,Oksengard AR, Ihle-Hansen H. Gait and balance one year afterstroke; relationships with lesion side, subtypes of cognitive impairment and neuroimaging findings:a longitudinal, cohort study[J]. Physiotherapy, 2018.[Epub ahead of print]
[35] Wu YZ, Lin JY, Wu PL, Kuo YF. Effects of a hybrid intervention combining exergaming and physical therapy among older adults in a long-term care facility[J]. Geriatr Gerontol Int, 2018.[Epub ahead of print]
[36] Dimori S, Leoni G, Fior L, Gasparotto F. Clinical nutrition and physical rehabilitation in a long-term care setting:preliminary observations in sarcopenic older patients[J]. Aging Clin Exp Res, 2018, 30:951-958.
[37] Buford TW, Hsu FC, Brinkley TE, Carter CS, Church TS,Dodson JA, Goodpaster BH, McDermott MM, Nicklas BJ, Yank V, Johnson JA, Pahor M; LIFE Research Group. Genetic influence on exercise-induced changes in physical functionamong mobility-limited older adults[J]. Physiol Genomics,2014, 46:149-158.
[38] Gallaway PJ, Miyake H, Buchowski MS, Shimada M, Yoshitake Y, Kim AS, Hongu N. Physical activity:a viable way to reduce the risks of mild cognitive impairment, Alzheimer's disease, and vascular dementia in older adults[J]. Brain Sci, 2017, 7:22-31.
[39] Hamed A, Bohm S, Mersmann F, Arampatzis A. Follow-up efficacy of physical exercise interventions on fall incidence and fall risk in healthy older adults:a systematic review and metaanalysis[J]. Sports Med Open, 2018, 4:56-59.
[40] Stevens JA, Lee R. The potential to reduce falls and avert costs by clinically managing fall risk[J]. Am J Prev Med, 2018, 55:290-297.
[2] Forsberg KM, Zhang Y, Reiners J, Ander M, Niedermayer A,Fang L, Neugebauer H, Kassubek J, Katona I, Weis J, Ludolph AC, Del Tredici K, Braak H, Yilmazer-Hanke D. Endothelial damage, vascular bagging and remodeling of the microvascular bed in human microangiopathy with deep white matter lesions[J]. Acta Neuropathol Commun, 2018, 6:128-135.
[3] Pirker W, Katzenschlager R. Gait disorders in adults and the elderly:a clinical guide[J]. Wiener Klinische Wochenschrift,2017, 129:81-95.
[4] Kerber KA, Enrietto JA, Jacobson KM, Baloh RW.Disequilibrium in older people[J]. Neurology, 1998, 51:574-580.
[5] Bazner H, Oster M, Daffertshofer M, Hennerici M. Assessmentof gait in subcortical vascular encephalopathy by computerized analysis:a cross-sectional and longitudinal study[J]. J Neurol,2000, 247:841-849.
[6] Baloh RW, Ying SH, Jacobson KM. A longitudinal study of gait and balance dysfunction in normal older people[J]. Arch Neurol, 2003, 60:835-839.
[7] van der Holst HM, Tuladhar AM, Zerbi V, van Uden IW, de Laat KF, van Leijsen EM, Ghafoorian M, Platel B, Bergkamp MI, van Norden AG, Norris DG, van Dijk EJ, Kiliaan AJ, de Leeuw FE. White matter changes and gait decline in cerebral small vessel disease[J]. Neuroimage Clin, 2017, 17:731-738.
[8] Ter Telgte A, van Leijsen EM, Wiegertjes K, Klijn CJ, Tuladhar AM. de Leeuw FE. Cerebral small vessel disease:from a focal to a global perspective[J]. Nat Rev Neurol, 2018, 14:387-398.
[9] Rosano C. Kuller LH, Chung H, Arnold AM, Longstreth WT Jr,Newman AB. Subclinical brain magnetic resonance imaging abnormalities predict physical functional decline in highfunctioning older adults[J]. J Am Geriatr Soc, 2005, 53:649-654.
[10] Pinter D, Ritchie SJ, Gattringer T, Bastin ME, Hernández MD,Corley J, Maniega SM, Pattie A, Dickie DA, Gow AJ, Starr JM,Deary IJ, Enzinger C, Fazekas F, Wardlaw J. Predictors of gait speed and its change over three years in community-dwelling older people[J]. Aging(Albany NY), 2018, 10:144-153.
[11] de Laat KF, Tuladhar AM, van Norden AG, Norris DG, Zwiers MP, de Leeuw FE. Loss of white matter integrity is associated with gait disorders in cerebral small vessel disease[J]. Brain,2011, 134(Pt 1):73-83.
[12] de Laat KF, van Norden AG, Gons RA, van Oudheusden LJ,van Uden IW, Norris DG, Zwiers MP, de Leeuw FE. Diffusion tensor imaging and gait in elderly persons with cerebral small vessel disease[J]. Stroke, 2011, 42:373-379.
[13] Longstreth WT Jr, Manolio TA, Arnold A, Burke GL, Bryan N,Jungreis CA, Enright PL, O'Leary D, Fried L. Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people:the Cardiovascular Health Study[J]. Stroke, 1996, 27:1274-1279.
[14] Blahak C, Baezner H, Pantoni L, Poggesi A, Chabriat H,Erkinjuntti T, Fazekas F, Ferro JM, Langhorne P, O'Brien J,Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D,Hennerici MG; LADIS Study Group. Deep frontal and periventricular age related white matter changes but not basal ganglia and infratentorial hyperintensities are associated with falls:cross sectional results from the LADIS study[J]. J Neurol Neurosurg Psychiatry, 2009, 80:608-613.
[15] Doi T, Shimada H, Makizako H, Tsutsumimoto K, Hotta R,Nakakubo S, Suzuki T. Effects of white matter lesions on trunk stability during dual-task walking among older adults with mild cognitive impairment[J]. Age(Dordr), 2015, 37:120-127.
[16] Novak V, Haertle M, Zhao P, Hu K, Munshi M, Novak P,Abduljalil A, Alsop D. White matter hyperintensities and dynamics of postural control[J]. Magn Reson Imaging, 2009, 27:752-759.
[17] You H, Zhang H, Liu J, Han T, Zhang M, Zhao W, Jiang S.Effect of balance training with Pro-kin System on balance in patients with white matter lesions[J]. Medicine(Baltimore),2017, 96:E9057.
[18] Zheng JJ, Delbaere K, Close JC, Sachdev PS. Lord SR. Impact of white matter lesions on physical functioning and fall risk in older people:a systematic review[J]. Stroke, 2011, 42:2086-2090.
[19] Srikanth V, Beare R, Blizzard L, Phan T, Stapleton J, Chen J,Callisaya M, Martin K, Reutens D. Cerebral white matterlesions, gait, and the risk of incident falls:a prospective population-based study[J]. Stroke, 2009, 40:175-180.
[20] Corti MC, Baggio G, Sartori L, Barbato G, Manzato E,Musacchio E, Ferrucci L, Cardinali G, Donato D, Launer LJ,Zambon S, Crepaldi G, Guralnik JM. White matter lesions and the risk of incident hip fracture in older persons:results from the progetto veneto anziani study[J]. Arch Intern Med, 2007,167:1745-1751.
[21] Zheng JJ, Delbaere K, Close JC, Sachdev P, Wen W, Brodaty H, Lord SR. White matter hyperintensities are an independent predictor of physical decline in community-dwelling older people[J]. Gerontology, 2012, 58:398-406.
[22] Willey JZ, Moon YP, Dhamoon MS, Kulick ER, Bagci A,Alperin N, Cheung YK, Wright CB, Sacco RL, Elkind MS.Regional subclinical cerebrovascular disease is associated with balance in an elderly multi-ethnic population[J].Neuroepidemiology, 2018, 51(1/2):57-63.
[23] Zeng W, Liu F, Wang Q, Wang Y, Ma L, Zhang Y. Parkinson's disease classification using gait analysis via deterministic learning[J]. Neurosci Lett, 2016, 28:268-278.
[24] Hikosaka O, Kim HF, Yasuda M, Yamamoto S. Basal ganglia circuits for reward value-guided behavior[J]. Annu Rev Neurosci, 2014, 37:289-306.
[25] Fujino Y, Amimoto K, Sugimoto S, Fukata K, Inoue M, Uchino A, Takahashi H, Makita S. Relationship of white matter lesions and severity of pushing behavior after stroke[J]. J Phys Ther Sci, 2017, 29:2116-2120.
[26] Moscufo N, Wakefield DB, Meier DS, Cavallari M, Guttmann CR, White WB, Wolfson L. Longitudinal microstructural changes of cerebral white matter and their association with mobility performance in older persons[J]. PLoS One, 2018, 13:E0194051.
[27] Watanabe T, Saito K, Ishida K, Tanabe S, Nojima I. Auditory stimulus has a larger effect on anticipatory postural adjustments in older than young adults during choice step reaction[J]. Eur J Appl Physiol, 2017, 117:2409-2423.
[28] Lee YH, Song GG. Interventions to prevent falls in older adults[J]. JAMA, 2018, 319:1382-1389.
[29] Pantoni L, Basile AM, Pracucci G, Asplund K, Bogousslavsky J, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, O'brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D. Impact of age-related cerebral white matter changes on the transition to disability. The LADIS study:rationale, design and methodology[J]. Neuroepidemiology,2014, 24(1/2):51-62.
[30] Lauretani F, Ticinesi A, Gionti L, Prati B, Nouvenne A, Tana C, Meschi T, Maggio M. Short-Physical Performance Battery(SPPB)score is associated with falls in older outpatients[J].Aging Clin Expe Res, 2018.[Epub ahead of print]
[31] Ghanavati T, Smitt MS, Lord SR, Sachdev P, Wen W, Kochan NA, Brodaty H, Delbaere K. Deep white matter hyperintensities, microstructural integrity and dual task walking in older people[J]. Brain Imag Behav, 2018, 12:1488-1496.
[32] Auvinet B, Touzard C, Montestruc F, Delafond A, Goeb V. Gait disorders in the elderly and dual task gait analysis:a new approach for identifying motor phenotypes[J].J Neuroeng Rehabil, 2017, 14:7-15.
[33] Taylor ME, Lord SR, Delbaere K, Wen W, Jiang J, Brodaty H,Kurrle SE, Stefanie Mikolaizak A, Close JC. White matter hyperintensities are associated with falls in older people with dementia[J]. Brain Imaging Behav, 2018, 25:9943-9948.
[34] Ursin MH, Bergland A, Fure B, Thommessen B, Hagberg G,Oksengard AR, Ihle-Hansen H. Gait and balance one year afterstroke; relationships with lesion side, subtypes of cognitive impairment and neuroimaging findings:a longitudinal, cohort study[J]. Physiotherapy, 2018.[Epub ahead of print]
[35] Wu YZ, Lin JY, Wu PL, Kuo YF. Effects of a hybrid intervention combining exergaming and physical therapy among older adults in a long-term care facility[J]. Geriatr Gerontol Int, 2018.[Epub ahead of print]
[36] Dimori S, Leoni G, Fior L, Gasparotto F. Clinical nutrition and physical rehabilitation in a long-term care setting:preliminary observations in sarcopenic older patients[J]. Aging Clin Exp Res, 2018, 30:951-958.
[37] Buford TW, Hsu FC, Brinkley TE, Carter CS, Church TS,Dodson JA, Goodpaster BH, McDermott MM, Nicklas BJ, Yank V, Johnson JA, Pahor M; LIFE Research Group. Genetic influence on exercise-induced changes in physical functionamong mobility-limited older adults[J]. Physiol Genomics,2014, 46:149-158.
[38] Gallaway PJ, Miyake H, Buchowski MS, Shimada M, Yoshitake Y, Kim AS, Hongu N. Physical activity:a viable way to reduce the risks of mild cognitive impairment, Alzheimer's disease, and vascular dementia in older adults[J]. Brain Sci, 2017, 7:22-31.
[39] Hamed A, Bohm S, Mersmann F, Arampatzis A. Follow-up efficacy of physical exercise interventions on fall incidence and fall risk in healthy older adults:a systematic review and metaanalysis[J]. Sports Med Open, 2018, 4:56-59.
[40] Stevens JA, Lee R. The potential to reduce falls and avert costs by clinically managing fall risk[J]. Am J Prev Med, 2018, 55:290-297.