Gait speed an early marker of covert CSVD?

A cross-sectional analysis presented at ISC 2026 suggests that a decline in mobility is an earlier functional manifestation of covert cerebral small vessel disease (CSVD) than cognitive impairment.

“[Our study showed that] in urban community-dwelling older adults, gait speed may serve as an early marker of covert CSVD,” noted Cheng-Yu Ku, a medical student from the National Yang Ming Chiao Tung University, Hsinchu, Taiwan, at ISC 2026.

In the multivariate linear regression model, CSVD was independently associated with slower gait speed (β, –0.16; p=0.04), but not with cognitive outcomes. “This is noteworthy because it suggests that even after controlling for age and sex, slower walking speed may be independently associated with high CSVD burden,” said Ku.

Conversely, asymptomatic intracranial atherosclerotic stenosis (ICAS) was not associated with either cognitive or physical function.

The preclinical stage: A long, silent phase

“It is important to understand that cerebrovascular disease is not a single event but a continuous, progressive spectrum. Classically, clinical attention focuses on its clinical stage (eg, stroke) or the advanced stage marked by vascular dementia or severe disability,” Ku noted.

However, the preclinical stage preceding these two stages is a long, silent phase in which vascular pathologies are already accumulating in the brain, yet patients remain clinically asymptomatic, she emphasized.

Currently, identifying these pathologies is possible via neuroimaging studies, which has led to the core question of this research, Ku noted. “We hypothesized that before the brain fails structurally like in a stroke, it fails functionally in [other] ways. Therefore, our goal was to [identify] the earliest clinical markers that can signal this covert burden.”

Using data from the Longitudinal Aging Study of Taipei cohort, Ku and colleagues evaluated 219 community-dwelling older adults without a history of stroke or dementia (median age 71 years, 67.6 percent women). Of these, 28 percent had covert CSVD and 7 percent had asymptomatic ICAS.

The total CSVD burden was assessed using a simplified CSVD score, ranging from 0 to 3 (high burden: ≥2 points), based on white matter hyperintensities, lacunes, and cerebral microbleeds. ICAS was defined as the presence of ≥50 percent stenosis on MRA involving the anterior cerebral artery, middle cerebral artery, and distal internal carotid artery.

Why not cognition?

The findings support gait speed as a sensitive clinical marker of CSVD, which affects deeper brain structures more than ICAS, Ku noted. “The findings [also] emphasize the importance of distinguishing the functional trajectories of different cerebrovascular pathologies in ageing populations.”

Ku attributed the lack of association with cognitive outcomes to ‘cognitive reserve’. “Our urban cohort is highly educated with an average of 14 years of schooling. This cognitive reserve may have effectively masked early cognitive decline.”

“Therefore, in this high-functioning population, gait speed might be an indicator of cerebrovascular risk, offering a window for early detection,” Ku concluded.