Abstract
BACKGROUND: Gait disturbance is a prevalent characteristic of cerebral small vessel disease (CSVD), yet the underlying mechanisms remain largely unclear. AIMES: To test the hypothesis that enlarged perivascular spaces in the basal ganglia (BG-EPVS) are related to gait performance in individuals with CSVD and the elderly. METHODS: This cross-sectional study included 138 CSVD patients and 62 healthy elderly controls who underwent quantitative gait analysis. Neuroimaging markers, including BG-EPVS, white matter hyperintensities (WMH), lacunes, and cerebral microbleeds (CMB), were assessed using MRI. Principal component analysis (PCA) was used to reduce the dimensionality of multiple gait indicators. Linear regression models were employed to examine the relationship between BG-EPVS and the principal component values of gait performance, with WMH as a potential mediator. RESULTS: Compared to healthy controls, CSVD patients exhibited significantly prolonged stance and double-support phases, shortened swing phase, reduced gait speed, increased step width, and decreased stride length and step height (p < 0.05 for all comparisons). Higher BG-EPVS grades were independently associated with poorer gait performance in both CSVD patients (p = 0.012) and all subjects (p = 0.001), even after adjusting for other CSVD markers. WMH partially mediated the relationship between BG-EPVS and gait performance, accounting for 18.2% of the total effect in CSVD patients and 24.9% of the total effects in all subjects. CONCLUSION: BG-EPVS is independently associated with gait disturbances in both CSVD patients and the elderly. These findings underscore the importance of early gait assessment in the aging population. Further longitudinal research is needed to confirm these associations.