Research: MAIDAN and COLLEAGUES,

Listed in Issue 270

Abstract

MAIDAN and COLLEAGUES, 1. From the Center for the Study of Movement, Cognition, and Mobility, Neurological Institute (I.M., K.R.-K., Y.J., N.G., J.M.H., A.M.), and Laboratory of Early Markers of Neurodegeneration (A.M.), Tel Aviv Sourasky Medical Center; Sagol School of Neuroscience (N.G., J.M.H., A.M.) and Departments of Neurology & Neurosurgery (N.G., A.M.) and Physical Therapy (J.M.H.), Sackler Faculty of Medicine, Tel Aviv University, Israel; and Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery (J.M.H.), Rush University Medical Center, Chicago, IL; 2. From the Center for the Study of Movement, Cognition, and Mobility, Neurological Institute (I.M., K.R.-K., Y.J., N.G., J.M.H., A.M.), and Laboratory of Early Markers of Neurodegeneration (A.M.), Tel Aviv Sourasky Medical Center; Sagol School of Neuroscience (N.G., J.M.H., A.M.) and Departments of Neurology & Neurosurgery (N.G., A.M.) and Physical Therapy (J.M.H.), Sackler Faculty of Medicine, Tel Aviv University, Israel; and Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery (J.M.H.), Rush University Medical Center, Chicago, IL. anatmi@tlvmc.gov.il conducted a randomized controlled trial to compare the effects of 2 forms of exercise upon brain activation in patients with Parkinson disease (PD).

Background

To compare the effects of 2 forms of exercise, i.e., a 6-week trial of treadmill training with virtual reality (TT + VR) that targets motor and cognitive aspects of safe ambulation and a 6-week trial of treadmill training alone (TT), on brain activation in patients with Parkinson disease (PD).

Methodology

As part of a randomized controlled trial, patients were randomly assigned to 6 weeks of TT (n = 17, mean age 71.5 ± 1.5 years, disease duration 11.6 ± 1.6 years; 70% men) or TT + VR (n = 17, mean age 71.2 ± 1.7 years, disease duration 7.9 ± 1.4 years; 65% men). A previously validated fMRI imagery paradigm assessed changes in neural activation pre-training and post-training. Participants imagined themselves walking in 2 virtual scenes projected in the fMRI: (1) a clear path and (2) a path with virtual obstacles. Whole brain and region of interest analyses were performed.

Results

Brain activation patterns were similar between training arms before the interventions. After training, participants in the TT + VR arm had lower activation than the TT arm in Brodmann area 10 and the inferior frontal gyrus (cluster level familywise error-corrected [FWEcorr] p < 0.012), while the TT arm had lower activation than TT + VR in the cerebellum and middle temporal gyrus (cluster level FWEcorr p < 0.001). Changes in fall frequency and brain activation were correlated in the TT + VR arm.

Conclusion

Exercise modifies brain activation patterns in patients with PD in a mode-specific manner. Motor-cognitive training decreased the reliance on frontal regions, which apparently resulted in improved function, perhaps reflecting increased brain efficiency.

References

Maidan I1, Rosenberg-Katz K1, Jacob Y1, Giladi N1, Hausdorff JM1, Mirelman A2. Disparate effects of training on brain activation in Parkinson disease. Neurology. 89(17):1804-1810. 24 Oct 2017. doi: 10.1212/WNL.0000000000004576. Epub Sep 27 2017.

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