Basal Ganglia and Prefrontal Regions Influence Postural Control and Cognitive Impairment in Parkinson's Disease

Abstract

ObjectivePostural instability is one of clinical manifestations caused by the deterioration of basal ganglia (BG) in Parkinson's disease (PD). It has frequently been found in moderate and advanced stages of the disease, simultaneously, impairments of cognition and executive function are also commonly present. Several studies reported interferences between postural control and cognitive tasks passing the prefrontal regions. We aimed to reveal the roles of BG and prefrontal regions in postural control and cognitive impairment in PD patients who exhibit freezing of gait (FOG).MethodsWe measured postural control in 60 patients with Parkinson's disease (PD) in on‐medication (39 PD patients with FOG and 21 PD patients without FOG). A Nintendo Wii balance board was utilized to measure postural stability in terms of center of pressure (CoP). A modified Hoehn and Yahr scale (H&Y) was used to classify clinical staging of PD. Subjects' disease severities were evaluated by using Unified Parkinson's Disease Rating Scale (UPDRS) (part III). Levodopa Equivalent Dose (LED), New Freezing of Gait questionnaire (NFOG‐Q), and Montreal Cognitive Assessment were also assessed. The participants were instructed to stand naturally on the balance platform and look at a marker, which was 3 meters from the board. The subjects were asked to perform counting days backward for a total of 170 seconds. A computer program collected the data automatically (Buated, W., et.al. Gerontology and Geriatric Medicine, 2016). Regression analysis were performed for posturographic and clinical variables to identify relationships of mild cognitive impairment, postural instability and FOG. An important parameter of CoP; path length (PL), which was found to be dominant factor of the balance analysis (Buated, W., et al. The 19th International Congress of Parkinson's Disease and Movement Disorders, 2015), was also calculated. Principal component analysis was used to analyze all clinical variables and determined the statistical significance of the variance.ResultsAssociations between PL and clinical variables were observed in all patients; LED (R2 = 0.150, p = 0.001), H&Y (R2 = 0.060, p = 0.060), duration of disease (R2 = 0.065, p < 0.049) and NFOG‐Q (R2 = 0.108, p = 0.010). In PD patients with FOG, relationship was found in LED (R2 = 0.125, p = 0.032). On the other hand, no relationship was noticed in PD patients without FOG.ConclusionsBasal ganglia and prefrontal regions play important roles in postural control and cognitive function in PD patients. Freezing of gait (FOG), cognitive impairment and postural control are associated with the effects of medication. Among the clinical variables, the correlation between LED and PL was found to be most important. These influences of the interruption of the neural circuitry were expressed in the postural control of PD patients, especially those subjects with FOG symptoms.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.