Effective connectivity of neural networks in automatic movements in Parkinson's disease.

Patients with Parkinson's disease (PD) have difficulty in performing learned movements automatically. The neural mechanism of this deficiency remains unclear. In the current study, we used functional MRI (fMRI) and psychophysiological interaction (PPI) methods to investigate the changes in effective connectivity of the brain networks when movements become automatic in PD patients and age-matched normal controls. We found that during automaticity, the rostral supplementary motor area, cerebellum, and cingulate motor area had increased effective connectivity with brain networks in PD patients. In controls, in addition to these regions, the putamen also had automaticity-related strengthened interactions with brain networks. The dorsal lateral prefrontal cortex had more connectivity at the novel stage than in the automatic stage in normal subjects, but not in PD patients. The comparison of the PPI results between the groups showed that the rostral supplementary motor area, cerebellum, and cingulate motor area had significantly more increased effective connectivity with several regions in normal subjects than in PD. The changes of effective connectivity in some areas negatively correlated with the Unified Parkinson's Disease Rating Scale (UPDRS). Our findings show that some of the factors related to PD patients having difficulty achieving automaticity are less efficient neural coding of movement and failure to shift execution of automatic movements more subcortically. The changes of effective connectivity become more abnormal as the disorder progresses. In addition, in PD, the connections of the attentional networks are altered.