Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
J Neurol. 2020 Apr;267(4):1116-1126. doi: 10.1007/s00415-019-09687-1. Epub 2020 Jan 2.
In this study, we assessed brain functional MRI (fMRI) activity during a foot movement task in Parkinson's disease patients with (PD-FoG) and without freezing of gait (PD-noFoG). Twenty-seven PD patients (17 PD-FoG) and 18 healthy controls (HC) were recruited. PD-FoG cases were divided into nine with mild and eight with moderate FoG according to the FoG questionnaire. Patients underwent motor and neuropsychological evaluations. Both patients and controls performed an fMRI task consisting of alternate dorsal/plantar foot flexion movements according to an auditory stimulus of 0.5 Hz. PD-FoG and PD-noFoG patients were similar for all motor variables (except for the presence of FoG). PD-FoG patients performed worse in executive, attention and working memory, visuospatial, language and memory cognitive tests relative to HC and in executive and language functions compared with PD-noFoG patients. While PD-noFoG patients showed an increased recruitment of the fronto-striatal circuit relative to HC during the fMRI task, PD-FoG subjects showed an increased activity of the parieto-occipital and cerebellar areas compared with HC and a reduced basal ganglia activity when compared with PD-noFoG patients. Within the PD-FoG group, patients with more severe FoG scores showed a decreased recruitment of fronto-parietal areas relative to less severe cases. fMRI modifications correlated with FoG severity and with executive-attentive and visuospatial deficits in PD-FoG patients. This study revealed the presence of two different patterns of brain activity during a foot movement task in PD-FoG and PD-noFoG patients, suggesting a possible compensatory role of parieto-occipital networks to overcome the fronto-striatal failure in PD-FoG cases.
在这项研究中，我们评估了帕金森病患者（PD-FoG）和无冻结步态的帕金森病患者（PD-noFoG）在进行足部运动任务时的大脑功能磁共振成像（fMRI）活动。招募了 27 名帕金森病患者（17 名 PD-FoG）和 18 名健康对照者（HC）。根据冻结步态问卷，将 PD-FoG 病例分为轻度 9 例和中度 8 例。患者接受了运动和神经心理学评估。患者和对照组均根据 0.5Hz 的听觉刺激进行交替的背/足底足趾屈曲运动的 fMRI 任务。除了存在冻结步态外，PD-FoG 和 PD-noFoG 患者在所有运动变量上均相似。与 HC 相比，PD-FoG 患者在执行、注意力和工作记忆、视空间、语言和记忆认知测试中表现较差，与 PD-noFoG 患者相比，在执行和语言功能方面表现较差。虽然 PD-noFoG 患者在 fMRI 任务中相对于 HC 显示出额纹状体回路的募集增加，但 PD-FoG 患者与 HC 相比显示出顶枕叶和小脑区域的活性增加，与 PD-noFoG 患者相比基底节活性降低。在 PD-FoG 组中，具有更严重冻结步态评分的患者相对于较轻的病例，显示出额顶区域募集的减少。fMRI 改变与 PD-FoG 患者的冻结步态严重程度以及执行注意和视空间缺陷相关。本研究揭示了 PD-FoG 和 PD-noFoG 患者在进行足部运动任务时存在两种不同的大脑活动模式，这表明顶枕叶网络可能发挥代偿作用，以克服 PD-FoG 病例中的额纹状体失败。
