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Age and Ageing Advance Access originally published online on March 18, 2009
Age and Ageing 2009 38(3):302-307; doi:10.1093/ageing/afp003
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© The Author 2009. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Higher level gait disorders in subcortical chronic vascular encephalopathy: a single photon emission computed tomography study

Maria Chiara Carboncini1, Duccio Volterrani2, Luca Bonfiglio1, Gabriele Barsotti1, Mauro Della Porta2, Giuliano Mariani2 and Bruno Rossi1

1 Neurorehabilitation Unit, Department of Neurosciences, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
2 Nuclear Medicine Unit, Department of Diagnostic Imaging, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy

Address correspondence to: Maria Chiara Carboncini. Tel: (+39) 050995581; Fax: (+39) 050995724. Email: m.carboncini{at}ao-pisa.toscana.it

Background: the so-called higher level gait disorders include several types of gait disorders in which there are no major modifications in strength, tone, sensitivity, coordination and balance. Brain activation sites related to walking have been investigated using SPECT in humans. The aim of the study was to investigate brain activation during walking in subjects with high-level gait disorders due to chronic subcortical vascular encephalopathy.

Subjects: twelve patients with a chronic vascular encephalopathy were enrolled in the study. Seven subjects had apraxic gait while in the other five the gait was normal. All patients had undergone a recent cerebral magnetic resonance that revealed diffused chronic ischemic lesions within the white matter.

Methods: all 12 patients underwent a regional cerebral blood flow (rCBF) brain SPECT study with 99mTc-Bicisate on two separate days and under two different conditions: at rest (baseline) and while walking (functional).

Results: the rCBF increase induced by the treadmill test (functional–baseline), bilaterally in the medial frontal gyrus and in the anterior lobes of the cerebellum, resulted significantly (P < 0.001) lower in patients with gait apraxia versus those without it.

Conclusions: this study of the brain with SPECT records the areas of perfusion deficit that appear in apraxic subjects when they walk, compared with the recordings obtained with the same investigation performed at rest.

Keywords: higher level gait disorders, cerebrovascular disease, SPECT, elderly

Received 27 May 2008; accepted in revised form 21 January 2009.


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