Cerebral Hemodynamic Responses to the Difficulty Level of Ambulatory Tasks in Patients With Parkinson’s Disease: A Systematic Review and Meta-Analysis

Abstract

Background. Ambulatory tasks are the important components of balance training which effectively improve postural stability and functional activities in persons with Parkinson’s disease (PD). The difficulty level of an ambulatory task is usually set in the form of attention, direction, speed, or amplitude requirement. Objectives. This study aimed to explore the neural mechanisms of cerebral hemodynamic responses to the difficulty level of ambulatory tasks in persons with PD. Methods. We included ten studies that examined cerebral hemodynamic responses during ambulatory tasks at different difficulty levels in persons with PD. The change in hemodynamic responses was synthesized and meta-analyzed. Results. Patients during “ON” medication had higher relative change in oxygenated hemoglobin (ΔHBO2) in the prefrontal cortex in response to difficulty levels of ambulatory tasks, which is comparable to that in healthy elderly individuals. However, patients during “OFF” medication did not show cortical activation in response to difficulty levels. During the lower-difficulty tasks, patients during “ON” medication demonstrated higher ΔHBO2 than healthy elderly participants and patients during “OFF” medication. Factors found to significantly contribute to the heterogeneity across studies included subjects’ type and cognitive status, task duration, setting, and filter used for functional near-infrared spectroscopy (fNIRS) data pre-processing. Conclusions. The findings suggest that ambulatory task at a higher difficulty level could be necessary to train the cortical capacity of PD persons, which should be conducted during “ON” medication; meanwhile, the contributing factors to the heterogeneity of studies would be useful as a reference when designing comparable fNIRS studies.

The impact of aerobic and resistance training intensity on markers of neuroplasticity in health and disease

“…The number of studies or the percent of heterogeneity did not drive the somewhat higher effect size for high-intensity training effects in NEU (N s = 12, I 2 = 71 %) than HOA (N s =14, I 2 = 49 %). While there have been reviews examining the effects of fitness, acute and chronic bouts of exercise on markers of NP in PwMS, PwPD, and PwST, none did metaanalytically examine interactions among exercise type, exercise intensity, NP domains, and populations (Ada et al, 2006;Calautti and Baron, 2003;Cruickshank et al, 2015;Diechmann et al, 2021;Dorsch et al, 2018;Ferreira et al, 2021;Gamborg et al, 2022;Hvid et al, 2021;Jorgensen et al, 2017;Lin et al, 2021;Ploughman et al, 2015;Ramazzina et al, 2017;Roeder et al, 2015;Ruiz-Gonzalez et al, 2021;Salter et al, 2016;Sandroff et al, 2020;Tablerion et al, 2020;Tillman et al, 2015;Wonsetler and Bowden, 2017). Our results in NEU agree with the general conclusions of these reviews that high-intensity AT is a feasible rehabilitation option for each of the three patient groups with the caveat that potential intensity-related side effects rarely assessed or reported (see limitation 4 in Section 4.4).…”

Influence of the constraint-induced method of constraint-induced movement therapy on improving lower limb outcomes after stroke: A meta-analysis review

“…If two factors are strongly correlated with each other ( r > 0.7), only the factor with the higher proportion of variance in the single-variable model was entered into the first mixed-variable regression model. A subgroup analysis was used to investigate factors contributing to heterogeneity when the number of studies was insufficient to conduct a meta-regression ( 27 ).…”

Increased Effective Connectivity of the Left Parietal Lobe During Walking Tasks in Parkinson’s Disease

“…Compared with EEG, fMRI, and PET, portable fNIRS allows the recording of brain signals during walking tasks in real environments. A meta-analysis of PD based on fNIRS including 10 studies that focused on the oxyhemoglobin in the prefrontal cortex (PFC) of individuals with PD during different difficulty levels of ambulatory walking tasks showed that, compared to healthy older individuals, individuals with PD in the on state showed increased mobilization of the PFC, while during the off-state no significant changes were identified [ 19 ]. In another review, which included 5 fNIRS studies related to PD, the activation of PFC in individuals with PD was higher than that in older adults during the walking task performed at a comfortable pace [ 17 ].…”