Maidan Inbal, Rosenberg-Katz Keren, Jacob Yael, Giladi Nir, Hausdorff Jeffrey M, Mirelman Anat
From the Center for the Study of Movement, Cognition, and Mobility, Neurological Institute (I.M., K.R.-K., Y.J., N.G., J.M.H., A.M.), and Laboratory of Early Markers of Neurodegeneration (A.M.), Tel Aviv Sourasky Medical Center; Sagol School of Neuroscience (N.G., J.M.H., A.M.) and Departments of Neurology & Neurosurgery (N.G., A.M.) and Physical Therapy (J.M.H.), Sackler Faculty of Medicine, Tel Aviv University, Israel; and Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery (J.M.H.), Rush University Medical Center, Chicago, IL.
Neurology. 2017 Oct 24;89(17):1804-1810. doi: 10.1212/WNL.0000000000004576. Epub 2017 Sep 27.
To compare the effects of 2 forms of exercise, i.e., a 6-week trial of treadmill training with virtual reality (TT + VR) that targets motor and cognitive aspects of safe ambulation and a 6-week trial of treadmill training alone (TT), on brain activation in patients with Parkinson disease (PD).
As part of a randomized controlled trial, patients were randomly assigned to 6 weeks of TT (n = 17, mean age 71.5 ± 1.5 years, disease duration 11.6 ± 1.6 years; 70% men) or TT + VR (n = 17, mean age 71.2 ± 1.7 years, disease duration 7.9 ± 1.4 years; 65% men). A previously validated fMRI imagery paradigm assessed changes in neural activation pretraining and post-training. Participants imagined themselves walking in 2 virtual scenes projected in the fMRI: (1) a clear path and (2) a path with virtual obstacles. Whole brain and region of interest analyses were performed.
Brain activation patterns were similar between training arms before the interventions. After training, participants in the TT + VR arm had lower activation than the TT arm in Brodmann area 10 and the inferior frontal gyrus (cluster level familywise error-corrected [FWEcorr] < 0.012), while the TT arm had lower activation than TT + VR in the cerebellum and middle temporal gyrus (cluster level FWEcorr < 0.001). Changes in fall frequency and brain activation were correlated in the TT + VR arm.
Exercise modifies brain activation patterns in patients with PD in a mode-specific manner. Motor-cognitive training decreased the reliance on frontal regions, which apparently resulted in improved function, perhaps reflecting increased brain efficiency.
比较两种运动形式对帕金森病（PD）患者大脑激活的影响，即为期6周的结合虚拟现实的跑步机训练（TT + VR），该训练针对安全步行的运动和认知方面，以及为期6周的单纯跑步机训练（TT）。
作为一项随机对照试验的一部分，患者被随机分配接受6周的TT训练（n = 17，平均年龄71.5 ± 1.5岁，病程11.6 ± 1.6年；70%为男性）或TT + VR训练（n = 17，平均年龄71.2 ± 1.7岁，病程7.9 ± 1.4年；65%为男性）。一种先前经过验证的功能磁共振成像（fMRI）图像范式评估了训练前和训练后神经激活的变化。参与者想象自己在fMRI中投射的两个虚拟场景中行走：（1）一条清晰的路径和（2）一条有虚拟障碍物的路径。进行了全脑和感兴趣区域分析。
干预前，两组训练的大脑激活模式相似。训练后，TT + VR组在布罗德曼区10和额下回的激活低于TT组（聚类水平家族性错误校正[FWEcorr] < 0.012），而TT组在小脑和颞中回的激活低于TT + VR组（聚类水平FWEcorr < 0.001）。TT + VR组的跌倒频率变化与大脑激活相关。
运动以特定模式的方式改变PD患者的大脑激活模式。运动 - 认知训练减少了对额叶区域的依赖，这显然导致了功能改善，可能反映了大脑效率的提高。
