Yale School of Medicine, Department of Neurology, Division of Movement Disorders, 15 York St, LCI 710, New Haven, CT 06510, USA; Yale School of Medicine, Clinical Neuroscience Imaging Center, 789 Howard Ave, New Haven, CT 06519, USA.
Yale School of Medicine, Department of Neurology, Division of Movement Disorders, 15 York St, LCI 710, New Haven, CT 06510, USA; Yale School of Medicine, Clinical Neuroscience Imaging Center, 789 Howard Ave, New Haven, CT 06519, USA.
Neuroimage Clin. 2022;34:102980. doi: 10.1016/j.nicl.2022.102980. Epub 2022 Mar 2.
Parkinson's disease (PD) causes difficulty with maintaining the speed, size, and vigor of movements, especially when they are internally generated. We previously proposed that the insula is important in motivating intentional movement via its connections with the dorsomedial frontal cortex (dmFC). We demonstrated that subjects with PD can increase the right insula-dmFC functional connectivity using fMRI-based neurofeedback (NF) combined with kinesthetic motor imagery (MI). The current study is a randomized clinical trial testing whether NF-guided kinesthetic MI training can improve motor performance and increase task-based and resting-state right insula-dmFC functional connectivity in subjects with PD.
We assigned nondemented subjects with mild PD (Hoehn & Yahr stage ≤ 3) to the experimental kinesthetic MI with NF (MI-NF, n = 22) and active control visual imagery (VI, n = 22) groups. Only the MI-NF group received NF-guided MI training (10-12 runs). The NF signal was based on the right insula-dmFC functional connectivity strength. All subjects also practiced their respective imagery tasks at home daily for 4 weeks. Post-training changes in 1) task-based and resting-state right insula-dmFC functional connectivity were the primary imaging outcomes, and 2) MDS-UPDRS motor exam and motor function scores were the primary and secondary clinical outcomes, respectively.
The MI-NF group was not significantly different from the VI group in any of the primary imaging or clinical outcome measures. The MI-NF group reported subjective improvement in kinesthetic body awareness. There was significant and comparable improvement only in motor function scores in both groups (secondary clinical outcome). This improvement correlated with NF regulation of the right insula-dmFC functional connectivity only in the MI-NF group. Both groups showed specific training effects in whole-brain functional connectivity with distinct neural circuits supporting kinesthetic motor and visual imagery (exploratory imaging outcome).
The functional connectivity-based NF regulation was unsuccessful, however, both kinesthetic MI and VI practice improved motor function in our cohort with mild PD.
帕金森病（PD）导致运动的速度、幅度和力度难以维持，尤其是当运动由内部产生时。我们之前提出，岛叶通过与背内侧前额叶皮层（dmFC）的连接，在激励意向运动方面发挥重要作用。我们已经证明，使用基于 fMRI 的神经反馈（NF）结合运动想象（MI），可以增加 PD 患者的右侧岛叶-dmFC 功能连接。本研究是一项随机临床试验，旨在测试 NF 指导的运动想象训练是否可以改善运动表现并增加 PD 患者的任务态和静息态右侧岛叶-dmFC 功能连接。
我们将非痴呆的轻度 PD（Hoehn & Yahr 分期≤3）患者分为实验性运动想象加 NF（MI-NF 组，n=22）和主动控制视觉想象（VI 组，n=22）组。仅 MI-NF 组接受 NF 指导的 MI 训练（10-12 次运行）。NF 信号基于右侧岛叶-dmFC 功能连接强度。所有患者还在家中每天练习各自的想象任务，持续 4 周。训练后的主要影像学结果为 1）任务态和静息态右侧岛叶-dmFC 功能连接的变化，主要和次要临床结果分别为 2）MDS-UPDRS 运动检查和运动功能评分。
MI-NF 组在任何主要影像学或临床结果测量上与 VI 组均无显著差异。MI-NF 组报告了运动身体感知的主观改善。只有两组的运动功能评分都有显著和可比的改善（次要临床结果）。这种改善仅与 MI-NF 组的右侧岛叶-dmFC 功能连接的 NF 调节相关。两组在支持运动和视觉想象的全脑功能连接上都表现出特定的训练效应（探索性影像学结果）。
尽管基于功能连接的 NF 调节不成功，但在我们轻度 PD 患者队列中，运动想象和视觉想象练习都改善了运动功能。
