Cognitive and oculomotor impairments mediate gait disorder in cerebral small vessel disease

Cerebral small vessel disease (CSVD) is associated with a range of gait disorders that are not entirely accounted for by conventional neuroimaging burden. This study aimed to elucidate the neuroimaging markers related to CSVD, alongside cognitive and oculomotor impairments, to explore potential mediating pathways affecting gait performance. A total of 65 CSVD patients and 35 age-matched healthy controls underwent multi-modal assessments, including quantitative gait analysis, comprehensive neuropsychological tests, and objective eye-tracking measurements. Participants were stratified based on gait status while ensuring a comparable total CSVD load. Correlation analyses revealed significant relationships between neuroimaging markers and measures of gait, cognition, and oculomotor function, while mediation analyses indicated that executive dysfunction, as measured by the Trail Making Test–B, fully mediated the effect of total CSVD load on gait performance. Moreover, processing speed (Trail Making Test–A) and specific oculomotor measures, such as saccade latency and fixation stability, played critical mediating roles. These findings suggest that executive dysfunction and oculomotor deficits are pivotal pathways linking CSVD to gait disorder. Consequently, this study supports a dual-pathway model of network inefficiency and underscores the need for early risk stratification and targeted interventions to improve mobility in CSVD.