Imaging Cerebral Glucose Metabolism during Dual‐Task Walking in Patients with Parkinson's disease

Abstract

BACKGROUND AND PURPOSE: Gait impairment is a hallmark of Parkinson's disease (PD). Natural walking involves more cognitive demand than treadmill walking or in-laboratory walking tests because patients have to actively work on navigation and top-down cognitive control which taxes cognitive reserve in the prefrontal cortex. To mimic the prefrontal engagement occurring with natural walking in a controlled and safe environment, dual-task (DT) treadmill walking has been developed. In this study, we tested the feasibility of imaging DT walking-related changes in brain glucose metabolism in patients with PD. METHODS: Fifteen patients with PD were scanned with fluorodeoxyglucose (FDG) positron emission tomography. Five patients performed DT walking, and 10 patients were rested during the FDG uptake period. First, the images were contrasted between the groups. Second, the walking-related brain glucose metabolism was inspected at the individual level. RESULTS: Consistently increased glucose metabolism was identified in DT walking versus rest in the primary visual/sensorimotor areas, thalamus, superior colliculus, and cerebellum. In individual level analysis, patients with less progressed disease (n = 3) showed prefrontal activity during DT walking while patients with more progressed disease (n = 2) did not. CONCLUSION: This study confirms the feasibility of imaging glucose metabolism during DT walking in patients with PD. We also report that during DT walking, there is a lesser degree of prefrontal engagement in the patients with more progressed disease compared to those with less progressed disease, implying increased degrees of frontal dysfunction with PD progression.

Changes in Metabolic Activity and Gait Function by Dual-Task Cognitive Game-Based Treadmill System in Parkinson’s Disease: Protocol of a Randomized Controlled Trial

“…In a recent pilot study, we tested the feasibility of imaging the DT-walking-related changes in brain glucose metabolism in patients with PD (Szturm et al, 2020). Fifteen patients with PD (stage II and III) were scanned with FDG-PET.…”

Computerized Dual-Task Testing of Gait Visuomotor and Cognitive Functions in Parkinson’s Disease: Test-Retest Reliability and Validity

“…Similar fNIRS studies evaluating PD patients have reported no difference in PFC activation levels for DT-walking trials as compared to walk-only trials (Holtzer et al, 2015;Maidan et al, 2016;Liu et al, 2021). A recent positron emission tomography pilot study of DT-walking evaluated brain glucose metabolism in PD (Hoehn and Yahr stages 2 and 3) in ten patients who rested and five who conducted a DT treadmill/cognitive video game task during the uptake period (Szturm et al, 2020). DT interference (DTI) was consistently shown for gait and cognitive game performance measures for the DT-walking group.…”

“…Cortical areas devoted to visuospatial processing of behaviorally significant information, such as the PFC may be particularly susceptible to the neurodegenerative process in PD (Klencklen et al, 2012;Battisto et al, 2018;Lally et al, 2020). To overcome these limitations, Szturm et al (2017Szturm et al ( , 2020 developed a computer game-based rehabilitation treadmill platform (GRP; Mahana et al, 2021) which provides an integrated approach to assess and treat the decline in balance, gait, visuomotor, and executive cognitive functions. The GRP consists of a standard treadmill instrumented with a pressure mapping system used to compute spatiotemporal gait variables and gait stability measures (Szturm et al, 2017;Ahmadi et al, 2018Ahmadi et al, , 2019 and a computer display placed at the front of the treadmill for participants to view and interact with computer-generated activities while walking.…”

The Contribution of Type 2 Diabetes to Parkinson’s Disease Aetiology

“…Patients in the early stages of PD have regional brain glucose hypometabolism, including the posterior temporoparietal, occipital, frontal, prefrontal, sensorimotor cortex and cerebellum putamen, pallidum, SNpc, and caudate [28,[84][85][86][87][88]. The treatment of PD patients modifies brain glucose consumption.…”