Are gait disturbances and white matter degeneration early indicators of vascular dementia?

The objective of this study was to correlate clinical and brain imaging findings with walking inabilities in patients with possible vascular dementia. For 24 patients with suspected initial vascular dementia according to DSM-III-R, structured neurological, neuropsychological and neuroimaging (magnetic resonance tomography) examinations were evaluated alongside computerized gait analysis. All patients revealed an increased variability of gait lines of various degrees: mild (11%), moderate (32%) and severe (57%). Lateralization of gait patterns was present in 68% and bipedal instabilities of posture in 54%. These findings were significantly correlated with frontal periventricular white matter lesions (WMLs), which probably affect the thalamo-cortico-mediocapsular pathways. The association of gait abnormalities with WMLs of the frontocentral subcortical and periventricular territories in patients with possible vascular dementing illnesses may be used as an early indicator of the disease for follow-up and treatment trials. However, since the degree of gait impairment varies considerably relative to the common mild intellectual limitations, these structural lesions are unlikely to be directly related to the dementing process.