College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Graduate Program in Biomedical Engineering, University of Manitoba, Winnipeg, Manitoba, Canada.
J Neuroimaging. 2021 Mar;31(2):356-362. doi: 10.1111/jon.12812. Epub 2020 Dec 8.
Gait impairment is a hallmark of Parkinson's disease (PD). Natural walking involves more cognitive demand than treadmill walking or in-laboratory walking tests because patients have to actively work on navigation and top-down cognitive control which taxes cognitive reserve in the prefrontal cortex. To mimic the prefrontal engagement occurring with natural walking in a controlled and safe environment, dual-task (DT) treadmill walking has been developed. In this study, we tested the feasibility of imaging DT walking-related changes in brain glucose metabolism in patients with PD.
Fifteen patients with PD were scanned with fluorodeoxyglucose (FDG) positron emission tomography. Five patients performed DT walking, and 10 patients were rested during the FDG uptake period. First, the images were contrasted between the groups. Second, the walking-related brain glucose metabolism was inspected at the individual level.
Consistently increased glucose metabolism was identified in DT walking versus rest in the primary visual/sensorimotor areas, thalamus, superior colliculus, and cerebellum. In individual level analysis, patients with less progressed disease (n = 3) showed prefrontal activity during DT walking while patients with more progressed disease (n = 2) did not.
This study confirms the feasibility of imaging glucose metabolism during DT walking in patients with PD. We also report that during DT walking, there is a lesser degree of prefrontal engagement in the patients with more progressed disease compared to those with less progressed disease, implying increased degrees of frontal dysfunction with PD progression.
步态障碍是帕金森病（PD）的一个标志。自然行走比跑步机行走或实验室行走测试需要更多的认知需求，因为患者必须积极进行导航和自上而下的认知控制，这会消耗前额叶皮层的认知储备。为了在受控和安全的环境中模拟自然行走时发生的前额叶参与，已经开发了双重任务（DT）跑步机行走。在这项研究中，我们测试了使用氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）对 PD 患者进行 DT 行走相关脑葡萄糖代谢成像的可行性。
对 15 名 PD 患者进行了氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）扫描。5 名患者进行了 DT 行走，10 名患者在 FDG 摄取期间休息。首先，在组间对比图像。其次，在个体水平上检查与行走相关的脑葡萄糖代谢。
与休息相比，DT 行走时，原发性视觉/感觉运动区、丘脑、上丘和小脑的葡萄糖代谢明显增加。在个体水平分析中，疾病进展程度较低的患者（n=3）在 DT 行走时表现出前额叶活动，而疾病进展程度较高的患者（n=2）则没有。
本研究证实了在 PD 患者中进行 DT 行走时成像葡萄糖代谢的可行性。我们还报告说，与疾病进展程度较低的患者相比，在 DT 行走期间，疾病进展程度较高的患者前额叶参与程度较小，这意味着随着 PD 进展，额叶功能障碍程度增加。
