Objective: We investigated brain structural and functional changes associated with falls.

Background: Gait and balance disorders are one of the common clinical features of Parkinson’s disease (PD) and falls in PD have great impact on patient’s activity of daily living (ADL) and quality of life (QOL).

Methods: We recruited 91 PD patients (38 men and 53 women, age 69.0±8.8, Hoehn-Yahr (H-Y) 2.9±1.0) admitted to our hospital. In addition to background characteristics, we evaluated gait and balance ability, motor symptom, and cognitive function. As an imaging analysis, we obtained 3D T1-weighted images of all patients and resting state functional MRI data of 58 patients using 3 Tesla MRI scanner (GE Healthcare). We performed VBM analysis using Statistical Parametric Mapping 8 (SPM8) and compared the gray matter volume of the patients with and without falls. We included age, gender, H-Y stage, MDS-UPDRS part 3, and freezing severity as covariates. We also investigated functional connectivity alterations using the CONN-fMRI Functional Connectivity toolbox v16 (http://www.nitrc.org/projects/conn).

Results: Among 91 patients, 55 patients had experienced falls. There were significant differences in clinical measures between patients with and without falls, including severity of freezing of gait, disease duration, MDS-UPDRS part1, part2, part3, part4, Berg Balance Scale, Frontal Assessment Battery, and Hamilton rating scale for depression. In patients with falls, significant gray matter volume reduction by the VBM analysis controlling several confounding factors in the right supra temporal gyrus (STG) and the right inferior parietal lobule (IPL). Resting state fMRI analysis showed decreased functional connectivity among the right posterior perisylvian region including IPL and STG, bil. Pallidum, and bil. supplementary motor area.

Conclusions: These findings suggested that the impaired brain network including the right IPL, STG, and bil basal ganglia is associated with frequent falls. Considering the suggested function of the right IPL, STG, impaired sensory integration and visuospatial attention might associate with the frequent falls in PD. Although future studies would be needed, above-mentioned cortical areas might be future therapeutic targets in neuromodulative intervention for fall prevention.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/brain-structural-and-functional-changes-associated-with-frequent-falls-in-parkinsons-disease/