NEURAL CORRELATES OF GAIT HYPOKINESIA IN PARKINSON'S DISEASE: AN FMRI STUDY

Introduction: Brisk walking (BW) is an efficient tool to study gait hypokinesia whose pathogenesis remains poorly understood in Parkinson's disease (PD). Aims: Assuming that brain regions recruited during imagined gait strongly overlap with those recruited during real gait, we used mental imagery of BW as a paradigm to study the neural correlates of gait hypokinesia in PD with BOLD fMRI. Methods: 15 'on-drugs' PD patients and 15 controls matched for age and gender were instructed to imagine themselves in two situations: comfortable walking (CW) and BW on a 25 meter-path. Imagined speed reserve (ISR), defined as the difference between imagined BW and CW speeds, was measured as a control of behavioral performance. The first-level individual contrast images representing the comparison between BW and CW were entered into second-level analyses with the corresponding ISRs as correlation regressors. Results: ISRs and their real counterparts measured offline were significantly decreased in patients relatively to controls. They strongly positively correlated in patients (Pearson's r = 0.88) and controls (Pearson's r = 0.59). Between-group comparison of individual contrasts BW minus CW in correlation with their corresponding ISRs showed that increasing imagined gait speed was strongly associated with increased activity of the left posterior parietal cortex (PPC) in controls and with decreased activity of this region in the patients. Conclusions: Our findings suggest that gait hypokinesia is related to an impaired function of the left PPC in PD. The left PPC may represent a target for therapeutic interventions aimed at alleviating gait disturbances in PD