Objective: To study gait parameters and functional MRI (fMRI) patterns performing dual-task in Parkinson’s disease patients with postural instability and gait disorders phenotype (PD-PIGD) and to assess correlations between brain functional activity and gait during dual-task.

Background: Previous studies suggested that PD patients need to hyper-activate brain cognitive networks to control movement. Thus dual-task performance is usually difficult for PD patients, resulting in increased gait difficulties and postural instability.

Method: Twenty PD-PIGD patients performed Timed-Up-and-Go (TUG) test, TUG with motor (TUG-MOT) and cognitive (TUG-COG) dual-tasks. TUG-MOT consisted of TUG while holding a glass full of water and TUG-COG consisted of TUG while counting backwards by threes from 100. A six cameras SMART-DX7000 optoelectronic system was used to obtain peak and mean velocity during the turning phase. Patients performed also two fMRI tasks: i) motor-task (foot anti-phase movements); ii) dual-task (foot anti-phase movements while counting backwards by threes starting from 100).

Results: PD-PIGD patients showed increased total time of execution and slower turns during TUG-MOT and TUG-COG relative to simple TUG. During fMRI dual-task relative to motor-task, patients showed increased activation of the fronto-temporo-parietal regions and decreased activity of the sensorimotor areas. Correlation analysis showed that: i) better TUG performance correlated with increased recruitment of the cortical/cerebellar motor areas, the fronto-striatal circuit and the occipital lobe during the motor-task; ii) better TUG-MOT/TUG-COG performance correlated with increased activity of motor areas and decreased recruitment of superior/middle frontal and temporal gyri, superior/inferior parietal gyri, occipital areas and right pallidum during the dual-task.

Conclusion: Dual-task resulted in a slower gait performance particularly during turning, a challenging situation in PD-PIGD patients. This pattern might reflect an increased dynamic postural instability when high cognitive load is requested. FMRI results suggest that an optimized recruitment of motor and cognitive networks is associated with a better dual-task performance.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dual-task-in-parkinsons-disease-a-gait-analysis-and-functional-mri-study/