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Brain activation pattern related to gait disturbances in Parkinson's disease§

Authors

  • Julien Crémers MD,

    Corresponding author
    1. Movere Group, Cyclotron Research Center, University of Liège, Liège, Belgium
    2. Department of Neurology, University Hospital Center of Liège, Liège, Belgium
    • Cyclotron Research Center, 8 Allée du 6 Août (B30), University of Liège, B-4000 Liège, Belgium
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  • Kevin D'Ostilio MPsy,

    1. Movere Group, Cyclotron Research Center, University of Liège, Liège, Belgium
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  • Julien Stamatakis MAppSc,

    1. Movere Group, Cyclotron Research Center, University of Liège, Liège, Belgium
    2. Institute of Information and Communication Technologies, Electronics and Applied Mathematics, University of Louvain, Louvain, Belgium
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  • Valérie Delvaux MD, PhD,

    1. Department of Neurology, University Hospital Center of Liège, Liège, Belgium
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  • Gaëtan Garraux MD, PhD

    1. Movere Group, Cyclotron Research Center, University of Liège, Liège, Belgium
    2. Department of Neurology, University Hospital Center of Liège, Liège, Belgium
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  • Funding agencies: This work was supported by a Michael J. Fox Foundation for Parkinson Research Grant awarded under the Critical Challenges in PD 2009 - Postural Instability and Gait Disturbances Program.

  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • §

    Full financial disclosures and author roles may be found in the online version of this article.

Abstract

Gait disturbances represent a therapeutic challenge in Parkinson's disease (PD). To further investigate their underlying pathophysiological mechanisms, we compared brain activation related to mental imagery of gait between 15 PD patients and 15 age-matched controls using a block-design functional MRI experiment. On average, patients showed altered locomotion relatively to controls, as assessed with a standardized gait test that evaluated the severity of PD-related gait disturbances on a 25-m path. The experiment was conducted in the subjects as they rehearsed themselves walking on the same path with a gait pattern similar as that during locomotor evaluation. Imagined walking times were measured on a trial-by-trial basis as a control of behavioral performance. In both groups, mean imagined walking time was not significantly different from that measured during real gait on the path used for evaluation. The between-group comparison of the mental gait activation pattern with reference to mental imagery of standing showed hypoactivations within parieto-occipital regions, along with the left hippocampus, midline/lateral cerebellum, and presumed pedunculopontine nucleus/mesencephalic locomotor area, in patients. More specifically, the activation level of the right posterior parietal cortex located within the impaired gait-related cognitive network decreased proportionally with the severity of gait disturbances scored on the path used for gait evaluation and mental imagery. These novel findings suggest that the right posterior parietal cortex dysfunction is strongly related to the severity of gait disturbances in PD. This region may represent a target for the development of therapeutic interventions for PD-related gait disturbances. © 2012 Movement Disorder Society

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