The severity of white matter lesions affects the gait of patients with small vessel disease, including spatiotemporal and kinematic parameters, symmetry, and variability, with toe-off angle, swing phase coefficient of variation, and age identified as independent risk factors for WMH-induced gait impairment.
Patients with moderate-to-severe WMH exhibited slower gait speed compared to those with mild WMH.
Patients with moderate-to-severe WMH had shorter stride length compared to those with mild WMH.
Patients with moderate-to-severe WMH demonstrated reduced foot strike and toe-off angles compared to those with mild WMH.
Gait parameter symmetry and variability were significantly increased in the moderate-to-severe WMH group.
Multivariate logistic regression identified toe-off angle, swing phase coefficient of variation, and age as independent risk factors for WMH-induced gait impairment.
This research suggests that in patients with cerebral small vessel disease (a condition involving damage to small blood vessels in the brain), the severity of white matter hyperintensities — bright spots visible on brain MRI scans that indicate areas of brain tissue damage — is directly linked to measurable changes in how people walk. Using a wearable sensor system to precisely measure gait in 335 hospitalized patients, the researchers found that those with more severe white matter damage walked more slowly, took shorter steps, and had altered foot angles when striking the ground and pushing off with their toes, compared to patients with milder white matter damage. Beyond these basic walking measurements, the study also found that more severely affected patients showed greater irregularity and asymmetry in their walking patterns — meaning their steps were less consistent and less even between left and right sides. This kind of variability in gait is associated with reduced balance and a higher risk of falls. Statistical analysis identified three key factors that independently predicted worse gait impairment: a reduced toe-off angle (how much the foot pushes off at the end of each step), greater variability in the swing phase of walking (how consistently the leg moves through the air), and older age. This research suggests that brain white matter damage in small vessel disease affects walking in multiple measurable ways, and that wearable gait analysis devices could be useful tools for detecting and tracking these changes in clinical settings. The findings highlight that older patients with small vessel disease and more extensive white matter lesions may be at particular risk for gait instability, which has implications for fall prevention and rehabilitation planning.
Wang Y, Zhu Z, Zhao J, Liu S. (2026). The relationship between white matter hyperintensity and gait in patients with cerebral small vessel disease.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1909850