Abstract
BackgroundWe hypothesized that the integrity of white matter might be related to the severity of freezing of gait in age-related white matter changes.MethodsTwenty subjects exhibiting excessive hyperintensities in the periventricular and deep white matter were recruited. The subjects underwent the Freezing of Gait Questionnaire, computerized gait analyses, and diffusion tensor magnetic resonance imaging. Images of axial, radial and mean diffusivity, and fractional anisotropy were calculated as indices of white matter integrity and analyzed with tract-based spatial statistics.ResultsThe fractional anisotropy, mean, axial and radial diffusivity averaged across the whole white matter structure were all significantly correlated with Freezing of Gait Questionnaire scores. Regionally, a negative correlation between Freezing of Gait Questionnaire scores and fractional anisotropy was found in the left superior longitudinal fasciculus beneath the left premotor cortex, right corpus callosum, and left cerebral peduncle. The scores of the Freezing of Gait Questionnaire were positively correlated with mean diffusivity in the left corona radiata and right corpus callosum, and with both axial and radial diffusivity in the left corona radiata. The white matter integrity in these tracts (except the corpus callosum) showed no correlation with cognitive or other gait measures, supporting the specificity of those abnormalities to freezing of gait.ConclusionDivergent pathological lesions involved neural circuits composed of the cerebral cortex, basal ganglia and brainstem, suggesting that freezing of gait has a multifactorial nature.
Highlights
We hypothesized that the integrity of white matter might be related to the severity of freezing of gait in age-related white matter changes
Correlation of Freezing of gait (FOG) with global changes in brain volumes and diffusion tensor imaging (DTI) measures The assessment of brain atrophy with SIENAX failed to show a correlation between Freezing of Gait Questionnaire (FOGQ) scores and the volume of the total brain (P = 0.59), gray matter (P = 0.68) or white matter (P = 0.10)
When the diffusion measures averaged across the mean white matter skeleton were assessed, FOGQ scores showed a significant negative correlation with mean fractional anisotropy (FA) (0.38 ± 0.032 r = −0.49, P = 0.026), and a significant positive correlation with mean diffusivity (MD) (0.99 ± 0.059 r = 0.50, P = 0.022), AD (1.4 ± 0.042, r = 0.48, P = 0.029) and RD (0.79 ± 0.069, r = 0.48, P = 0.031; Table 2)
Summary
We hypothesized that the integrity of white matter might be related to the severity of freezing of gait in age-related white matter changes. FOG is defined as an “inability to generate effective stepping movement” [1]. It is often observed in patients with idiopathic Parkinson’s disease (PD), and is even more prevalent in patients with atypical Parkinsonism (including vascular Parkinsonism) than in those with PD [2]. FOG can be seen in age-related white matter changes (ARWMC), which refer to the neuroradiological. The most reliable measure of the severity in FOG to date is the total score on the Freezing of Gait Questionnaire (FOGQ) [7]. A directional bias of water diffusion can be quantified by measuring fractional anisotropy (FA), while mean diffusivity (MD) indicates the degree of diffusion [8]
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