Orcioli-Silva Diego, Vitório Rodrigo, Nóbrega-Sousa Priscila, Beretta Victor Spiandor, Conceição Núbia Ribeiro da, Oliveira Anderson Souza, Pereira Marcelo Pinto, Gobbi Lilian Teresa Bucken
São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil.
Aalborg University, Aalborg, Denmark.
Neurorehabil Neural Repair. 2021 May;35(5):406-418. doi: 10.1177/15459683211000736. Epub 2021 Mar 23.
Dopaminergic medication improves gait in people with Parkinson disease (PD). However, it remains unclear if dopaminergic medication modulates cortical activity while walking.
We investigated the effects of dopaminergic medication on cortical activity during unobstructed walking and obstacle avoidance in people with PD.
A total of 23 individuals with PD, in both off (PD) and on (PD) medication states, and 30 healthy older adults (control group [CG]) performed unobstructed walking and obstacle avoidance conditions. Cortical activity was acquired through a combined functional near-infrared spectroscopy electroencephalography (EEG) system, along with gait parameters, through an electronic carpet. Prefrontal cortex (PFC) oxygenated hemoglobin (HbO) and EEG absolute power from FCz, Cz, and CPz channels were calculated.
HbO concentration reduced for people with PD during obstacle avoidance compared with unobstructed walking. In contrast, both people with PD and the CG had increased HbO concentration when avoiding obstacles compared with unobstructed walking. Dopaminergic medication increased step length, step velocity, and β and γ power in the CPz channel, regardless of walking condition. Moreover, dopaminergic-related changes (ie, on-off) in FCz/CPz γ power were associated with dopaminergic-related changes in step length for both walking conditions.
PD compromises the activation of the PFC during obstacle avoidance, and dopaminergic medication facilitates its recruitment. In addition, PD medication increases sensorimotor integration during walking by increasing posterior parietal cortex (CPz) activity. Increased γ power in the CPz and FCz channels is correlated with step length improvements achieved with dopaminergic medication during unobstructed walking and obstacle avoidance in PD.
多巴胺能药物可改善帕金森病（PD）患者的步态。然而，多巴胺能药物在行走过程中是否调节皮质活动仍不清楚。
我们研究了多巴胺能药物对PD患者在无障碍行走和避障过程中皮质活动的影响。
共有23例处于未服药（PD）和服药（PD）状态的PD患者以及30名健康老年人（对照组[CG]）进行了无障碍行走和避障测试。通过功能近红外光谱与脑电图（EEG）联合系统采集皮质活动，并通过电子地毯采集步态参数。计算前额叶皮质（PFC）的氧合血红蛋白（HbO）以及FCz、Cz和CPz通道的EEG绝对功率。
与无障碍行走相比，PD患者在避障过程中HbO浓度降低。相比之下，PD患者和CG在避障时的HbO浓度均高于无障碍行走时。无论行走状态如何，多巴胺能药物均可增加步长、步速以及CPz通道的β和γ功率。此外，两种行走状态下，FCz/CPzγ功率的多巴胺能相关变化（即服药与未服药）均与步长的多巴胺能相关变化有关。
PD会损害避障过程中PFC的激活，而多巴胺能药物有助于其恢复。此外，PD药物通过增加后顶叶皮质（CPz）的活动来增强行走过程中的感觉运动整合。在PD患者的无障碍行走和避障过程中，CPz和FCz通道γ功率的增加与多巴胺能药物引起的步长改善相关。
