Objective: To assess brain functional MRI (fMRI) activity during a feet movement task in Parkinson’s disease patients with (PD-FoG) and without freezing of gait (PD-noFoG) and healthy controls.

Background: To date, few studies have investigated task-based fMRI alterations underlying gait difficulties in PD-FoG patients, suggesting an abnormal interplay between motor, basal ganglia, pedunculopontine and cognitive control networks. However, the mechanisms underlying FoG pathophysiology are still debated.

Method: 10 PD-noFoG, 17 PD-FoG patients and 18 matched healthy controls were recruited. PD-FoG were divided into 9 with mild and 8 with moderate FoG according to the New FoG-Questionnaire (NFoG-Q). Patients underwent motor (Timed Up and Go test, 10-meters-walking test, UPDRSIII) and neuropsychological evaluations (executive-attentive, visuo-spatial and memory domains). Both patients and controls performed an fMRI task consisting of alternate dorsal/plantar feet flexion movements according to an auditory stimulus of 0.5 Hz.

Results: PD-FoG and PD-noFoG patients were similar for all motor variables except for the presence of FoG. Only PD-FoG patients performed worse in executive-attentive, visuo-spatial and memory functions relative to healthy controls. fMRI results showed decreased activity in sensorimotor areas in PD-FoG and PD-noFoG patients relative to healthy controls. PD-noFoG patients showed an increased activation of frontal-striatal network while PD-FoG subjects had an increased parieto-occipital and cerebellar cortices recruitment compared to healthy subjects. PD-FoG showed a decreased basal ganglia activity relative to PD-noFoG. Analysing PD-FoG subgroups, mild PD-FoG subjects revealed an increased fronto-parietal activation relative to moderate PD-FoG patients.

Conclusion: All PD subjects showed a decrease recruitment of sensorimotor areas during feet movements relative to healthy controls. Despite this common feature, this study revealed the presence of two different patterns of brain activity during feet movements in PD-FoG and PD-noFoG patients, suggesting a compensatory role of parieto-occipital network to overcome the fronto-striatal failure in PD-FoG subjects.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/different-patterns-of-brain-activity-during-lower-limb-movements-in-parkinsons-disease-patients-with-and-without-freezing-of-gait/