Objective: The purpose of this pilot study was to explore whether this combined cognitive and motor exercise program would 1) improve freezing of gait (FOG) 2) improve automaticity (walking performance under dual task) and 3) change functional connectivity between locomotor and frontal regions.

Background: FOG and postural impairments have been related to frontal lesions and frontal dysfunction such as impaired executive function. We have previously shown that the medial frontal cortex communication with the mesencephalic locomotor region is disordered in subjects with Parkinson’s disease (PD) and FOG [1]. This suggests that effective rehabilitation will need to engage these frontal areas of cortex in cognitively complex mobility tasks. 

Methods: In this cross-over design, 29 people with PD+FOG (age 68±7, MDS-UPDRS: 47±15) were randomized in either 6 weeks of exercise (Agility Boot Camp-Cognition) or education. Outcome measures (OFF medication) are: 1) an objective measures of FOG [2], 2) new FOG questionnaire (NFOG-Q), 3) dual task cost gait speed, 4) fMRI: right SMA-PPN connectivity (in a subset of 12 subjects) [1]. A linear mixed-model with order of treatment and treatment as fixed factors, subjects as random factor, and baseline values as covariates was used. 

Results: The FOG Ratio and NFOG-Q showed only a significant effect of the baseline covariates (F=8.6, p=0.005). This suggests that baseline performance impacted the degree of change with intervention. The dual task cost on gait speed showed a significant order effect (F=7.6, p=0.009). Lastly, the right SMA-PPN connectivity showed a significant treatment effect (F=6.9, p=0.01) in addition to the baseline covariate effect (F=19, p<0.0001).

Conclusions: The results from this pilot study show no significant improvement in FOG after intervention. However, there was a significant association for those people with more severe FOG to improve after exercise (r=-0.57, p=0.002) but not education (r=-0.32, p=0.08). The order effect found in dual task cost of gait speed is likely due to a carry-over improvement if the subjects did the exercise first (visual inspection). Moreover, there was a significant improvement in the locomotor network that we previously found to be altered in PD with FOG. These findings will help in planning a larger intervention study to improve mobility in PD.

References: 1. Fling, Brett W., et al. “Functional reorganization of the locomotor network in Parkinson patients with freezing of gait.” PLoS One 9.6 (2014): e100291.

2. Mancini, Martina, et al. “The Clinical Significance Of Freezing While Turning in Parkinson’s Disease.” Neuroscience (2016).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-combined-cognitive-and-motor-exercise-program-for-people-with-parkinsons-disease-and-freezing-of-gait-a-pilot-study/