Introduction Methods Results Results Discussion

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Di culty turning while walking is common among in Parkinson's disease (PD) and may lead to significant disability, freezing of gait. (FoG), falls and reduced ...
Cortical correlates of dual-task turning with and without freezing of gait Martina Mancini , Valeria Belluscio , Samuel Stuart 1

1,2

1

1 Department of Neurology, Oregon Health & Science University, Portland, OR 2 Universita’ degli Studi di Roma - Foro Italico Balance Disorders Laboratory

Results

Introduction Difficulty turning while walking is common among in Parkinson’s disease (PD) and may lead to significant disability, freezing of gait (FoG), falls and reduced mobility. Turning deficits have been related to executive-attentional mechanisms through dual-task paradigms, where prefrontal cortex (PFC) activity maybe implicated. However, the role of the PFC during turning under single or dual-task and association with FoG is not clear. OBJECTIVE This study investigated the relationship between the PFC activity and turning characteristics with and without a dual-task in people with PD with and without FoG.

PD shows specific impairments in turning quality compared to healthy controls # of turns 30

Duration (s)

*

*

9

25

20

15

10

5

0

CTR

PD-FOG PD+FOG

*

*

8

Peak Velocity (degrees/s) * 180 * 160

7

140

6

120

5

100

4

80

3

60

2

40

1

20

0

0

CTR

PD-FOG PD+FOG

CTR

PD-FOG PD+FOG

FoG Ratio 0.8

Freezing severity was higher in people with PD and FoG

Methods

0.7

*

0.6 0.5 0.4

Participants - 8 healthy controls - 32 subjects with PD - 17 non freezers - 15 freezers

CTR Age 66.5±5.5 8 Total of participants 5 N of Participants (males) Disease Duration (years) MDS-UPDRS_Part III MoCa 26.6±1.9 FAB Clock 1 Clock 2 TMT_A TMT_B

PD-FoG PD+FoG 69.9±4.3 66.9±5.0 17 15 13 11 9.35±6.7 13.5±6.0 33.5±11.2 46.9±11.8 25.4±3.8 28.7±1.3 13.7±3.1 15.4±2.4 12.1±1.5 11.7±0.8 13.7±1.5 13.1±5.5 45.4±16.2 78.5±71.2 68.4±24.5 129.9±57.4

p value 0.205 0.076 0.065 0.083 0.006 0.023 0.277 0.61 0.299 0.167 0.01

OUTCOMES fNIRS

Change in oxygenated hemoglobin (HbO2) while turning from baseline standing (proxy for cortical activity).

Inertial sensors:

- Turning duration - Turning Peak Velocity - Turning Jerkiness - FoG Ratio

TASKS - Turning in place, 120s, single-task (ST) - Turning in place, 120s, dual-task (DT, modified AX-CPT)

0

HbO2 change while turning is associated to FoG severity and visuospatial function in PD+FoG ST DT

TMT B-A MDS-UPDRS III

HbO2 change while turning is associated to # of turns in PD-FoG

0.8

0.8

TMT A

0.6 0.4

Turning Jerkiness

0.2

Clox

FoG Ratio

Percent Total Power

100 degrees/s

# turns Turning Duration Turning Velocity

20 2

4

6

8

10

Frequency (Hz)

Discussion

80 60

FoG Ratio=9.99

40 20 0

2

4

6

Frequency (Hz)

8

10

8s

PD+FoG shows poorer scores in the MDS-UPDRS Part III and executive function (Trail Making B) compared to PD-FoG PD+FoG showed higher PFC activation during turning consistently with an association between increased activity of the PFC and presence of FoG.

Results PFC Relative change in HbO2 (microM)

0.4

PFC activity while turning is higher in PD compared to healthy controls in ST, while showing opposite trends for DT condition

Clox

0

FoG Ratio=0.84

40

PD+FOG

Right 360 turn

0.4

Turning Jerkiness

Turning Velocity

8s

FoG

TMT A

0.6

Turning Duration

80 60

TMT B-A

# turns

PD-FOG

Trunk angular velocity (yaw) Right shin angular velocity Left shin angular velocity

PD-FOG PD+FOG

MDS-UPDRS III

B: Frequency-analysis

FoG

CTR

ST DT

FoG Ratio

0

PD+FOG

0.1

0

Percent Total Power

100 degrees/s

Right 360 turn

0.2

0.2

A: Time-analysis PD-FOG

0.3

ST DT

Visuospatial ability might be a contributor factor to FoG

0.3

0.2

0.1

0

-0.1

-0.2

-0.3

-0.4

CTR

PD-FoG

PD+FoG

Acknowledgements We thank our participants for generously donating their time to participate. Grants: NIH Career Development Award R00 HD078492 (Mancini), PCO Pilot Funding (Mancini)

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