Executive Control of Walking in People With Parkinson’s Disease With Freezing of Gait

Abstract

Background Walking abnormalities in people with Parkinson’s disease (PD) are characterized by a shift in locomotor control from healthy automaticity to compensatory prefrontal executive control. Indirect measures of automaticity of walking (eg, step-to-step variability and dual-task cost) suggest that freezing of gait (FoG) may be associated with reduced automaticity of walking. However, the influence of FoG status on actual prefrontal cortex (PFC) activity during walking remains unclear. Objective To investigate the influence of FoG status on automaticity of walking in people with PD. Methods Forty-seven people with PD were distributed into 2 groups based on FoG status, which was assessed by the New Freezing of Gait Questionnaire: PD−FoG (n = 23; UPDRS-III = 35) and PD+FoG (n = 24; UPDRS-III = 43.1). Participants walked over a 9-m straight path (with a 180° turn at each end) for 80 seconds. Two conditions were tested off medication: single- and dual-task walking (ie, with a concomitant cognitive task). A portable functional near-infrared spectroscopy system recorded PFC activity while walking (including turns). Wearable inertial sensors were used to calculate spatiotemporal gait parameters. Results PD+FoG had greater PFC activation during both single and dual-task walking than PD−FoG ( P = .031). There were no differences in gait between PD−FoG and PD+FoG. Both groups decreased gait speed ( P = .029) and stride length ( P < .001) during dual-task walking compared with single-task walking. Conclusions These findings suggest that PD+FoG have reduced automaticity of walking, even in absence of FoG episodes. PFC activity while walking seems to be more sensitive than gait measures in identifying reduction in automaticity of walking in PD+FoG.

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

“…To minimize heterogeneity across studies, ΔHBO 2 in the prefrontal cortex (PFC) was chosen for this meta-analysis because it is a unique measure presented in all studies. [13][14][15][16][17][18][19][27][28][29] Comprehensive Meta-Analysis software (Version 3, Biostat, Englewood, New Jersey) was used to perform the meta-analyses. To investigate how the difficulty levels of ambulatory tasks affected the cerebral hemodynamic response in persons with PD, the ambulatory tasks were divided into two levels of difficulty that were higher or lower in the form of difficulty parameters.…”

“…The resting duration before tasks was 20 s in most studies, 30 s and 45 s in one study, 13,27 or 25 to 45 s arranged in a pseudo-random order. 14 The task duration was 30 s, [13][14][15][16]27 80 s, [17][18][19]29 or time of a walking bout. 18,28 The block paradigm for ambulatory tasks was designed in six studies.…”

“…14 The distance from the transmitter to the detector was 3.5 cm in most studies, flexible from 3 to 4 cm in three studies, 15,16,28 and 3 cm in two studies. 14,27 The sampling rate was 10 Hz in five studies, 50 Hz in four studies, [17][18][19]29 and 7.81 Hz in one study. 27 A low-pass filter was used with a cut-off frequency of .14 Hz in most studies, .67 Hz and .1 Hz in one study, and a band-pass filter with a frequency of .01-.14 Hz in other three studies.…”

Aerobic Exercise Combined With Transcranial Direct Current Stimulation Over the Prefrontal Cortex in Parkinson Disease: Effects on Cortical Activity, Gait, and Cognition

“…28 However, to the best of our knowledge, the responses of PFC activity while walking and gait parameters to a combined session of aerobic exercise and anodal tDCS applied over the PFC have not been investigated yet. Since people with PD rely on prefrontal executive-attentional resources to control gait, 4-9 assessment of PFC activity while walking in response to such combined intervention is necessary to advance our understanding on potential cortical mechanisms underlying gait improvements. Thus, the aim of this study was to investigate the effects of adding anodal tDCS applied over the PFC to a session of aerobic exercise on gait, cognition, and PFC activity while walking in people with PD.…”

Comparing the Clinical and Neuropsychological Characteristics of Parkinson’s Disease With and Without Freezing of Gait

“…The underlying pathophysiology of FOG is not fully understood ( Vitorio et al, 2020 ). It is widely recognized that cognitive impairment (CI) plays an important role in developing and aggravating FOG in PD.…”