Gymnastik- och idrottshögskolan, GIH

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Cerebral small vessel disease, cardiovascular risk factors, and future walking speed in old age: a population-based cohort study.
Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Uppsala University, Sweden; Aging Research Center, Karolinska Institutet-Stockholm University, Sweden.ORCID iD: 0000-0001-7175-0093
Aging Research Center, Karolinska Institutet-Stockholm University, Sweden; Stockholm Gerontology Research Center, Sweden; Karolinska University Hospital, Stockholm, Sweden; Karolinska Institutet, Huddinge, Sweden.
Aging Research Center, Karolinska Institutet-Stockholm University, Sweden.
Karolinska Institutet, Karolinska University Hospital, Solna, Sweden.
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2021 (English)In: BMC Neurology, E-ISSN 1471-2377, Vol. 21, no 1, article id 496Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The purpose of this study was to examine the associations between combined and individual cerebral small vessel disease (cSVD) markers on future walking speed over 9 years; and to explore whether these associations varied by the presence of cardiovascular risk factors (CRFs).

METHODS: This population-based cohort study included 331 adults, aged ≥60 years, without limitation in walking speed (≥0.8 m/s). At baseline, cSVD markers, including white matter hyperintensities (WMH), lacunes, and perivascular spaces (PVS), were assessed on magnetic resonance imaging. The modifiable CRFs (physical inactivity, heavy alcohol consumption, smoking, hypertension, high total cholesterol, diabetes, and overweight/obese) were combined into a score. The association between baseline cSVD markers and the decline in walking speed was examined using linear mixed-effects models, whereas Cox proportional hazards models were used to estimate the association with walking speed limitation (defined as < 0.8 m/s) over the follow-up.

RESULTS: Over the follow-up period, 76 (23.0%) persons developed walking speed limitation. Participants in the highest tertile of the combined cSVD marker score had a hazard ratio (HR) of 3.78 (95% confidence interval [CI] 1.70-8.45) for walking speed limitation compared with people in the lowest score tertile, even after adjusting for socio-demographics, CRFs, cognitive function, and chronic conditions. When investigating the cSVD markers individually, having the highest burden of WMH was associated with a significantly faster decline in walking speed (β coefficient - 0.020; 95% CI -0.035-0.004) and a greater HR of walking speed limitation (HR 2.78; 95% CI 1.31-5.89) compared with having the lowest WMH burden. Similar results were obtained for the highest tertile of PVS (HR 2.13; 95% CI 1.04-4.36). Lacunes were associated with walking speed limitation, but only in men. Having ≥4 CRFs and high WMH volume simultaneously, showed a greater risk of walking speed limitation compared with having ≥4 CRFs and low WMH burden. CRFs did not modify the associations between lacunes or PVS and walking speed.

CONCLUSIONS: Combined cSVD markers strongly predict walking speed limitation in healthy older adults, independent of cognitive function, with WMH and PVS being the strongest contributors. Improving cardiovascular health may help to mitigate the negative effects of WMH on future walking speed.

Place, publisher, year, edition, pages
BioMed Central, 2021. Vol. 21, no 1, article id 496
Keywords [en]
Cardiovascular risk factors, Cerebral small vessel disease, Magnetic resonance imaging (MRI), Physical function, Population-based cohort study, Walking speed
National Category
Geriatrics
Research subject
Medicine/Technology
Identifiers
URN: urn:nbn:se:gih:diva-6889DOI: 10.1186/s12883-021-02529-6ISI: 000734159200001PubMedID: 34949170OAI: oai:DiVA.org:gih-6889DiVA, id: diva2:1624439
Available from: 2022-01-04 Created: 2022-01-04 Last updated: 2022-02-10

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Heiland, Emerald GWang, Rui

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