Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.
IRCCS Neuromed, Pozzilli, IS, Italy.
Cerebellum. 2019 Jun;18(3):298-308. doi: 10.1007/s12311-018-0988-4.
In this study, we aimed to evaluate the importance of cerebellum in freezing of gait (FOG) pathophysiology. Due to the fundamental role of the cerebellum in posture and gait control, we examined cerebellar structural and functional connectivity (FC) in patients with PD and FOG. We recruited 15 PD with FOG (PD-FOG), 16 PD without FOG (PD-nFOG) patients, and 16 healthy subjects (HS). The FOG Questionnaire (FOG-Q) assessed FOG severity. Three tesla-MRI study included resting-state functional MRI, diffusion tensor imaging (DTI), and 3D T1-w images. We located seed regions in the cerebellar locomotor region, fastigial, and dentate nucleus to evaluate their FC. DTI parameters were obtained on the superior, middle, and inferior cerebellar peduncles. Global and lobular cerebellum volumes were also calculated. Cerebellar locomotor and fastigial FC was higher in cerebellar and posterior cortical areas in PD-FOG than in HS. FC of the cerebellar locomotor region with cerebellar areas positively correlated with FOG-Q. Dentate FC was lower in the prefrontal and parieto-occipital cortices in PD-FOG than in HS and in the brainstem, right basal ganglia, and frontal and parieto-occipital cortices than in PD-nFOG. DTI parameters in superior and middle cerebellar peduncles were altered in PD-FOG compared with PD-nFOG and significantly correlated with FOG-Q. There were no differences in cerebellar volumes between PD-FOG and either PD-nFOG or HS. Our results suggest that altered connectivity of the cerebellum contributes to the pathophysiology of FOG. FC of the cerebellar locomotor region and white matter (WM) properties of cerebellar peduncles correlate with FOG severity, supporting the hypothesis that abnormal cerebellar function underlies FOG in PD.
在这项研究中,我们旨在评估小脑在冻结步态(FOG)发病机制中的重要性。由于小脑在姿势和步态控制中的基本作用,我们检查了 PD 伴 FOG(PD-FOG)患者、不伴 FOG(PD-nFOG)患者和健康对照者(HS)的小脑结构和功能连接(FC)。我们招募了 15 名 PD-FOG 患者、16 名 PD-nFOG 患者和 16 名健康对照者。使用冻结步态问卷(FOG-Q)评估 FOG 严重程度。3T-MRI 研究包括静息态功能 MRI、弥散张量成像(DTI)和 3D T1 加权图像。我们定位小脑运动区、顶核和齿状核的种子区域以评估其 FC。在小脑上、中、下脚获得 DTI 参数。还计算了小脑整体和叶体积。与 HS 相比,PD-FOG 患者的小脑运动和顶核 FC 更高,位于小脑和皮质后区。小脑运动区与小脑区的 FC 与 FOG-Q 呈正相关。与 HS 相比,PD-FOG 患者的齿状核 FC 在前额和顶枕皮质较低,与 PD-nFOG 相比,在脑干、右侧基底节和额顶枕皮质较低。与 PD-nFOG 相比,PD-FOG 患者的上、中小脑脚的 DTI 参数发生改变,与 FOG-Q 显著相关。PD-FOG 与 PD-nFOG 或 HS 之间小脑体积无差异。我们的结果表明,小脑连接的改变有助于 FOG 的发病机制。小脑运动区的 FC 和小脑脚的白质(WM)特性与 FOG 严重程度相关,支持小脑功能异常是 PD 中 FOG 的基础这一假说。
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