Association between small vessel disease and slow gait speed in older adults with cognitive impairment.

Subjective cognitive decline and mild cognitive impairment are often associated with gait disturbances, increasing dementia risk. Cerebral small vessel disease (CSVD) may underlie these associations. Objective: To examine the association between CSVD lesion types and locations with slow gait speed in older adults with subjective cognitive decline and mild cognitive impairment. Methods: In this cross-sectional study, 124 older adults met the inclusion criteria. Participants underwent clinical evaluation, gait speed assessment, and brain magnetic resonance imaging. CSVD burden was assessed using the STRIVE-2 criteria and quantified using Fazekas and modified Scheltens scales. Logistic regression analyses were conducted to calculate odds ratios (OR) with 95% confidence intervals. Results: Individuals with slow gait were older, had lower education levels, and a higher prevalence of hypertension. Neuroimaging analysis revealed a significant association between slow gait and global white matter hyperintensities (WMH) burden (Fazekas score ≥2: 34.5 vs. 12.1%, p<0.003; Scheltens score ≥5: 65.8 vs. 42.4%, p<0.010). Regional WMH analysis showed increased burden in frontal and occipital regions in the slow gait group. Lacunar infarcts were more prevalent in the slow gait group (15.2 vs. 3.4%, p=0.028). Multivariate analysis revealed that lacunar infarcts and WMH in specific brain regions remained significant predictors of slow gait, even after adjusting for confounders. Conclusion: CSVD, particularly lacunar infarcts and specific WMH patterns, is associated with slow gait in this population. Early identification and management of CSVD may help mitigate its impact on gait and functional status.