Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA.
Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA.
Mov Disord. 2021 Nov;36(11):2559-2568. doi: 10.1002/mds.28684. Epub 2021 Jun 10.
Dysfunction of cerebellar vermis contributes to gait abnormalities in multiple conditions and may play a key role in gait impairment in Parkinson's disease (PD).
The purpose of this study was to investigate whether altered resting-state functional connectivity of the vermis relates to subsequent impairment of specific domains of gait in PD.
We conducted morphometric and resting-state functional connectivity MRI analyses contrasting 45 PD and 32 age-matched healthy participants. Quantitative gait measures were acquired with a GAITRite walkway at varying intervals after functional connectivity data acquisition.
At baseline, PD participants had significantly altered functional connectivity between vermis and sensorimotor cortex compared with controls. Altered vermal functional connectivity with bilateral paracentral lobules correlated with subsequent measures of variability in stride length, step time, and single support time after controlling for confounding variables including the interval between imaging and gait measures. Similarly, altered functional connectivity between vermis and left sensorimotor cortex correlated with mean stride length and its variability. Vermis volume did not relate to any gait measure. PD participants did not differ from controls in vermis volume or cortical thickness at the site of significant regional clusters. Only altered lobule V:sensorimotor cortex functional connectivity correlated with subsequent gait measures in exploratory analyses involving all the other cerebellar lobules.
These results demonstrate that abnormal vermal functional connectivity with sensorimotor cortex, in the absence of relevant vermal or cortical atrophy, correlates with subsequent gait impairment in PD. Our data reflect the potential of vermal functional connectivity as a novel imaging biomarker of gait impairment in PD. © 2021 International Parkinson and Movement Disorder Society.
小脑蚓部功能障碍与多种疾病的步态异常有关，并且可能在帕金森病（PD）的步态损害中发挥关键作用。
本研究旨在探讨小脑蚓部静息态功能连接的改变是否与 PD 患者步态特定领域的后续损害有关。
我们对比了 45 名 PD 患者和 32 名年龄匹配的健康对照者，进行了形态计量学和静息态功能连接 MRI 分析。在功能连接数据采集后的不同时间间隔，使用 GAITRite 步道采集定量步态测量值。
在基线时，与对照组相比，PD 患者小脑蚓部与感觉运动皮层之间的功能连接存在明显改变。在控制了包括成像和步态测量之间的时间间隔在内的混杂变量后，小脑蚓部与双侧旁中央小叶之间的改变的蚓部功能连接与步长、步时和单支撑时间的变异性的后续测量值相关。类似地，小脑蚓部与左感觉运动皮层之间的功能连接与平均步长及其变异性相关。小脑蚓部体积与任何步态测量值均无关。在存在显著区域聚类的部位，PD 患者的小脑蚓部体积或皮质厚度与对照组无差异。只有改变的小叶 V：感觉运动皮层功能连接与所有其他小脑小叶参与的探索性分析中的后续步态测量值相关。
这些结果表明，在没有相关的小脑蚓部或皮质萎缩的情况下，小脑蚓部与感觉运动皮层之间的异常功能连接与 PD 患者的后续步态损害相关。我们的数据反映了小脑蚓部功能连接作为 PD 步态损害的新型影像学生物标志物的潜力。© 2021 国际帕金森病和运动障碍学会。
