Assessment of Gait Disorders in Cerebral Small Vessel Disease: Advantages of Different Clinical Scales.

Abstract

Background/Objectives: Cerebral small vessel disease (cSVD) is one of the leading causes of gait disorders (GDs) in the elderly. Clinical diversity and lack of standardization in assessment of GDs in cSVD patients are associated with late diagnosis. The comparative value of clinical rating scales used for gait assessment in clinical studies of cSVD has not been previously clarified. The purpose of the study was to assess GDs in cSVD patients with different scales and evaluate the advantages of their usage in clinical practice. Materials and methods: The study included 124 cSVD patients (STRIVE, 2013) (average age 62.2 ± 7.9, women-53.2%) and 30 healthy volunteers (average age 59.77 ± 6.361, women-56.7%). Gait and balance function were assessed with the Tinetti test, "6-m walk" test, and the Clinical Scale for Assessing the Severity of Gait Disorders in SVD (RCN, 2019). Results: In total, 85 (68.5%) patients had gait disturbances. The "6-MWT" showed a general tendency to decrease gait speed, step length, and increase in base width. ROC analysis established their thresholds for GD diagnosis. Moderate- or high-risk of falls was found in 52 (41.9%) patients. Gait parameters assessed by two tests (Tinneti and 6-WMT) showed a high degree of intercorrelations. Comparative analysis of the quantitative parameters of Tinneti and 6-WMT tests revealed significant differences depending on the severity of the GD assessed by the Clinical Scale for Assessing the Severity of GDs in cSVD (RCN, 2019). Conclusions: GDs in cSVD are characterized by slowness, changes in step length, base width, and a high risk of falls. The Tinetti test and "6-MWT" have good reproducibility in cSVD, high correlations between the tests, as well as significant differences between the categories of GD severity, which justifies their use in cSVD patients. The advantage of the Tinetti test is the ability to perform a fall risk assessment, while "6-MWT" allows for the diagnosis of GD based on gait parameter thresholds, which is important in the early stages of the disease and in dynamic observation. The Clinical Scale for Assessing the Severity of Gait Disorders in cSVD is a convenient screening tool for assessing the severity of GDs in clinical practice.