title: Gray and white matter changes linking cerebral small vessel disease to gait disturbances.
abstract: OBJECTIVE
  To investigate the topographic changes of white matter (WM) integrity and cortical thickness related to gait disturbances and determine whether these neural correlates mediate the association between cerebral small vessel disease (CSVD) and gait disturbances.
  
  
  METHODS
  A total of 129 patients with subcortical vascular cognitive impairment were included. CSVD severity was quantified as global and regional WM hyperintensities (WMH) volume and lacune and microbleed numbers. Amyloid burdens were assessed using Pittsburgh compound B (PiB)-PET scanning. Gait score was measured using a standardized scale. WM integrity was assessed by applying tract-based spatial statistics. Cortical thickness was measured using surface-based methods. Path analysis for gait score was performed using regional CSVD markers as predictors and fractional anisotropy (FA) and cortical thickness as mediators.
  
  
  RESULTS
  Periventricular WMH (PWMH) volume was associated with gait score, regardless of other CSVD. PiB retention ratio was not associated with gait score. Gait score was correlated with FA in the frontal and parietal WM and bilateral corpus callosum and with cortical thinning in the bilateral frontal and lateral temporo-parieto-occipital regions. Path analysis for gait score showed that PWMH contributed to gait disturbances with the mediation of mean FA or cortical thickness.
  
  
  CONCLUSIONS
  Our findings suggest that WMH-related cortical thinning as well as disrupted integrity of periventricular WM is linked to gait disturbances.
authors.affiliation: From the Department of Neurology (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), Neuroscience Center (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), and Nuclear Medicine (K.H.L., Y.S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Biomedical Engineering (H.K.K., J.M.L.), Hanyang University; Department of Neurology (H.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Neurology (H.K.P.), Inje University Ilsan Paik Hospital, Goyang; and Radiology (S.T.K.) and Department of Neurology (Y.J.K.), Hallym University, Gangwon-do,Korea.
authors.forename: Yeo Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: From the Department of Neurology (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), Neuroscience Center (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), and Nuclear Medicine (K.H.L., Y.S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Biomedical Engineering (H.K.K., J.M.L.), Hanyang University; Department of Neurology (H.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Neurology (H.K.P.), Inje University Ilsan Paik Hospital, Goyang; and Radiology (S.T.K.) and Department of Neurology (Y.J.K.), Hallym University, Gangwon-do,Korea.
authors.forename: Hun Ki
authors.initials: HK
authors.lastname: Kwon
authors.affiliation: From the Department of Neurology (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), Neuroscience Center (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), and Nuclear Medicine (K.H.L., Y.S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Biomedical Engineering (H.K.K., J.M.L.), Hanyang University; Department of Neurology (H.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Neurology (H.K.P.), Inje University Ilsan Paik Hospital, Goyang; and Radiology (S.T.K.) and Department of Neurology (Y.J.K.), Hallym University, Gangwon-do,Korea.
authors.forename: Jong Min
authors.initials: JM
authors.lastname: Lee
authors.affiliation: From the Department of Neurology (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), Neuroscience Center (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), and Nuclear Medicine (K.H.L., Y.S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Biomedical Engineering (H.K.K., J.M.L.), Hanyang University; Department of Neurology (H.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Neurology (H.K.P.), Inje University Ilsan Paik Hospital, Goyang; and Radiology (S.T.K.) and Department of Neurology (Y.J.K.), Hallym University, Gangwon-do,Korea.
authors.forename: Hanna
authors.initials: H
authors.lastname: Cho
authors.affiliation: From the Department of Neurology (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), Neuroscience Center (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), and Nuclear Medicine (K.H.L., Y.S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Biomedical Engineering (H.K.K., J.M.L.), Hanyang University; Department of Neurology (H.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Neurology (H.K.P.), Inje University Ilsan Paik Hospital, Goyang; and Radiology (S.T.K.) and Department of Neurology (Y.J.K.), Hallym University, Gangwon-do,Korea.
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: From the Department of Neurology (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), Neuroscience Center (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), and Nuclear Medicine (K.H.L., Y.S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Biomedical Engineering (H.K.K., J.M.L.), Hanyang University; Department of Neurology (H.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Neurology (H.K.P.), Inje University Ilsan Paik Hospital, Goyang; and Radiology (S.T.K.) and Department of Neurology (Y.J.K.), Hallym University, Gangwon-do,Korea.
authors.forename: Hee Kyung
authors.initials: HK
authors.lastname: Park
authors.affiliation: From the Department of Neurology (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), Neuroscience Center (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), and Nuclear Medicine (K.H.L., Y.S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Biomedical Engineering (H.K.K., J.M.L.), Hanyang University; Department of Neurology (H.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Neurology (H.K.P.), Inje University Ilsan Paik Hospital, Goyang; and Radiology (S.T.K.) and Department of Neurology (Y.J.K.), Hallym University, Gangwon-do,Korea.
authors.forename: Na-Yeon
authors.initials: NY
authors.lastname: Jung
authors.affiliation: From the Department of Neurology (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), Neuroscience Center (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), and Nuclear Medicine (K.H.L., Y.S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Biomedical Engineering (H.K.K., J.M.L.), Hanyang University; Department of Neurology (H.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Neurology (H.K.P.), Inje University Ilsan Paik Hospital, Goyang; and Radiology (S.T.K.) and Department of Neurology (Y.J.K.), Hallym University, Gangwon-do,Korea.
authors.forename: Jin
authors.initials: J
authors.lastname: San Lee
authors.affiliation: From the Department of Neurology (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), Neuroscience Center (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), and Nuclear Medicine (K.H.L., Y.S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Biomedical Engineering (H.K.K., J.M.L.), Hanyang University; Department of Neurology (H.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Neurology (H.K.P.), Inje University Ilsan Paik Hospital, Goyang; and Radiology (S.T.K.) and Department of Neurology (Y.J.K.), Hallym University, Gangwon-do,Korea.
authors.forename: Juyoun
authors.initials: J
authors.lastname: Lee
authors.affiliation: From the Department of Neurology (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), Neuroscience Center (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), and Nuclear Medicine (K.H.L., Y.S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Biomedical Engineering (H.K.K., J.M.L.), Hanyang University; Department of Neurology (H.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Neurology (H.K.P.), Inje University Ilsan Paik Hospital, Goyang; and Radiology (S.T.K.) and Department of Neurology (Y.J.K.), Hallym University, Gangwon-do,Korea.
authors.forename: Young Kyoung
authors.initials: YK
authors.lastname: Jang
authors.affiliation: From the Department of Neurology (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), Neuroscience Center (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), and Nuclear Medicine (K.H.L., Y.S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Biomedical Engineering (H.K.K., J.M.L.), Hanyang University; Department of Neurology (H.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Neurology (H.K.P.), Inje University Ilsan Paik Hospital, Goyang; and Radiology (S.T.K.) and Department of Neurology (Y.J.K.), Hallym University, Gangwon-do,Korea.
authors.forename: Sung Tae
authors.initials: ST
authors.lastname: Kim
authors.affiliation: From the Department of Neurology (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), Neuroscience Center (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), and Nuclear Medicine (K.H.L., Y.S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Biomedical Engineering (H.K.K., J.M.L.), Hanyang University; Department of Neurology (H.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Neurology (H.K.P.), Inje University Ilsan Paik Hospital, Goyang; and Radiology (S.T.K.) and Department of Neurology (Y.J.K.), Hallym University, Gangwon-do,Korea.
authors.forename: Kyung Han
authors.initials: KH
authors.lastname: Lee
authors.affiliation: From the Department of Neurology (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), Neuroscience Center (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), and Nuclear Medicine (K.H.L., Y.S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Biomedical Engineering (H.K.K., J.M.L.), Hanyang University; Department of Neurology (H.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Neurology (H.K.P.), Inje University Ilsan Paik Hospital, Goyang; and Radiology (S.T.K.) and Department of Neurology (Y.J.K.), Hallym University, Gangwon-do,Korea.
authors.forename: Yearn Seong
authors.initials: YS
authors.lastname: Choe
authors.affiliation: From the Department of Neurology (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), Neuroscience Center (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), and Nuclear Medicine (K.H.L., Y.S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Biomedical Engineering (H.K.K., J.M.L.), Hanyang University; Department of Neurology (H.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Neurology (H.K.P.), Inje University Ilsan Paik Hospital, Goyang; and Radiology (S.T.K.) and Department of Neurology (Y.J.K.), Hallym University, Gangwon-do,Korea.
authors.forename: Yun Joong
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: From the Department of Neurology (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), Neuroscience Center (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), and Nuclear Medicine (K.H.L., Y.S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Biomedical Engineering (H.K.K., J.M.L.), Hanyang University; Department of Neurology (H.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Neurology (H.K.P.), Inje University Ilsan Paik Hospital, Goyang; and Radiology (S.T.K.) and Department of Neurology (Y.J.K.), Hallym University, Gangwon-do,Korea.
authors.forename: Duk L
authors.initials: DL
authors.lastname: Na
authors.affiliation: From the Department of Neurology (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), Neuroscience Center (Y.J.K., H.J.K., N.-Y.J., J.S.L., J.L., Y.K.J., D.L.N., S.W.S.), and Nuclear Medicine (K.H.L., Y.S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Biomedical Engineering (H.K.K., J.M.L.), Hanyang University; Department of Neurology (H.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Neurology (H.K.P.), Inje University Ilsan Paik Hospital, Goyang; and Radiology (S.T.K.) and Department of Neurology (Y.J.K.), Hallym University, Gangwon-do,Korea. sangwonseo@empal.com.
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Seo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002540:Cerebral Cortex / Q000473:pathology; D059345:Cerebral Small Vessel Diseases / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000175:diagnosis* / Q000209:etiology*; D066128:Gray Matter / Q000473:pathology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D066127:White Matter / Q000473:pathology*