Freezing of gait in Parkinson’s disease: gray and white matter abnormalities

Abstract

Freezing of gait (FOG) is a disabling disorder that often affects Parkinson's disease (PD) patients in advanced stages of the disease. To study structural gray matter (GM) and white matter (WM) changes in PD patients with and without FOG, twenty-one PD patients with FOG (PD-FOG), 16 PD patients without FOG (PD-nFOG) and 19 healthy subjects (HS) underwent a standardized MRI protocol. For the gray matter evaluation, cortical volume (CV), cortical thickness (CTh), and surface area (SA) were analyzed using the FreeSurfer pipeline. For the white matter evaluation, DTI images were analyzed using tracts constrained by underlying anatomy (TRACULA) toolbox in FreeSurfer. PD-FOG patients exhibited lower CTh than HS in the mesial surface of both cerebral hemispheres, including the superior frontal gyrus, paracentral lobule, posterior cingulate cortex, precuneus and pericalcarine cortex, and in the right dorsolateral prefrontal cortex. Moreover, significant WM changes were observed in PD-FOG patients in comparison with HS in the superior longitudinal fasciculus, uncinate fasciculus, cingulum cingulate gyrus and inferior longitudinal fasciculus (prevalently in the right hemisphere) and in the frontal radiations of the corpus callosum. DTI abnormalities in specific WM bundles correlated significantly with cognitive measures. The damage of multiple cortical areas involved in high-level gait control together with WM disruption between motor, cognitive and limbic structures may represent the anatomical correlate of FOG.

Age‐related changes in cortical and subcortical structures of healthy adult brains: A surface‐based morphometry study

“…In our study, we also found obvious significance in two regions. Pietracupa et al 27 also observed a significant decline in superior frontal and precuneus in Parkinson's disease, which was also found in our study. Thus, it is also necessary to consider various factors in the diagnosis of neurodegenerative diseases.…”

Diffusion Tensor Imaging in Parkinson's Disease and Parkinsonian Syndrome: A Systematic Review

“…A few studies revealed significant correlations between DTI changes and severities in terms of freezing of gait (17,40), risk of falling (16), severity of postural instability and gait disturbance (PIGD) symptoms (18), motor speed and balance (19), and the degree of tremor (41,42). Some studies, using DTI for classifying PD motor subtypes (73,95), have found differentiable group effects only, but no substantial clinical correlations were observed in patients. The abnormal DTI changes in specific regions are considered useful biomarkers that characterize PD symptomology or differentiate PD phenotypes, and thus may provide an enormous potential for managing treatment directions of PD.…”

Changes in Cortical Thickness in Patients With Early Parkinson’s Disease at Different Hoehn and Yahr Stages

“…A pattern of GM changes has been suggested to occur in the mesial frontal cortex in PD patients with FOG. Pietracupa et al (2017) found that PD patients with FOG exhibit significant changes in WM and cortical thinning of the mesial surface of the bilateral cerebral hemispheres. Vastik et al (2017) found that FOG was associated with regional GM atrophy in the mesial frontal and cingulate cortices.…”