Abstract
To explore the underlying pathogenic mechanism of Parkinson’s disease (PD) with concomitant postural abnormalities (PDPA) through the relationship between its gait and brain function characteristics. PD patients from the neurology outpatient clinic at Ruijin Hospital were recruited and grouped according to whether postural abnormalities (including camptocormia and Pisa syndrome) were present. PD-related scale assessments, three-dimensional gait tests and brain resting-state functional magnetic imaging were performed and analyzed. The gait characteristics independently associated with PDPA were decreased pelvic obliquity angle and progressive downward movement of the center of mass during walking. PDPA features included decreased functional connectivity between the left insula and bilateral supplementary motor area, which was significantly correlated with reduced Berg Balance Scale scores. Functional connectivity between the right insula and bilateral middle frontal gyrus was decreased and significantly correlated with a decreased pelvic obliquity angle and poor performance on the Timed Up and Go test. Moreover, through diffusion tensor imaging analysis, the average fractional anisotropy value of the fibers connecting the left insula and left supplementary motor area was shown to be decreased in PDPA. There is decreased functional connectivity among the insula, supplementary motor area and middle frontal gyrus with structural abnormalities between the left insula and the left supplementary motor area; these changes in brain connectivity are probably among the causes of gait dysfunction in PDPA and provide some clues regarding the pathogenic mechanisms of PDPA.
Highlights
Postural abnormality increases in prevalence as Parkinson’s disease (PD) progresses; the combination of these conditions is termed PD with concomitant postural abnormalities (PDPA)
The demographic features of subjects enrolled in gait analysis (Table 1) and those enrolled in fMRI analysis (Table 2) were comparable
Testing of a gait assistance robot design based on a mouse model of severe spinal cord damage showed that the direction of the trunk is closely related to the movement and muscle activity of the lower limbs and receives balance correction from the proprioceptive sensory feedback of the flexor and extensor muscles, highlighting the importance of trunk adjustment in balance during walking [35]
Summary
Postural abnormality increases in prevalence as Parkinson’s disease (PD) progresses; the combination of these conditions is termed PD with concomitant postural abnormalities (PDPA). Some studies demonstrated a correlation of the insula [11], pedunculopontine nucleus [12], and frontal lobes [13] with postural control, which may provide a reasonable basis for the exploration of postural control in PDPA. Among these affected brain areas, areas that are relatively anatomically superficial, such as the frontal lobes and the insula, might be potential therapeutic targets for noninvasive interventions, such as transcranial magnetic stimulation (TMS). We hypothesized that some brain areas connecting the frontal lobes or insula in PDPA were abnormal and were involved in the underlying pathogenic causes, subsequently affecting the gait ability of these patients. The results could help explain the mechanism of PDPA, which will be useful for developing potential interventions
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