Objective: To use a combined neurogenetic-neuroimaging approach to examine the functional consequences of preclinical dopaminergic nigrostriatal dysfunction in the human motor system. Specifically, we examined how a single heterozygous mutation in different genes associated with recessively inherited Parkinson disease alters the cortical control of sequential finger movements.
Methods:Nonmanifesting individuals carrying a single heterozygous Parkin (n ϭ 13) or PINK1 (n ϭ 9) mutation and 23 healthy controls without these mutations were studied with functional MRI (fMRI). During fMRI, participants performed simple sequences of three thumb-to-finger opposition movements with their right dominant hand. Since heterozygous Parkin and PINK1 mutations cause a latent dopaminergic nigrostriatal dysfunction, we predicted a compensatory recruitment of those rostral premotor areas that are normally implicated in the control of complex motor sequences. We expected this overactivity to be independent of the underlying genotype.Results: Task performance was comparable for all groups. The performance of a simple motor sequence task consistently activated the rostral supplementary motor area and right rostral dorsal premotor cortex in mutation carriers but not in controls. Task-related activation of these premotor areas was similar in carriers of a Parkin or PINK1 mutation.
Conclusion: Mutations in different genes linked to recessively inherited Parkinson disease areassociated with an additional recruitment of rostral supplementary motor area and rostral dorsal premotor cortex during a simple motor sequence task. These premotor areas were recruited independently of the underlying genotype. The observed activation most likely reflects a "generic" compensatory mechanism to maintain motor function in the context of a mild dopaminergic deficit. Neurology ® 2009;72:1041-1047 GLOSSARY BOLD ϭ blood oxygen level-dependent; CMA ϭ cingulate motor area; FDR ϭ false discovery rate; fMRI ϭ functional MRI; HRF ϭ hemodynamic response function; IPS ϭ intraparietal sulcus; M1 HAND ϭ primary motor hand area; PD ϭ Parkinson disease; PMd ϭ dorsal premotor cortex; SMA ϭ supplementary motor area; SPM ϭ statistical parametric mapping; SVC ϭ small volume correction; TE ϭ echo time; TMS ϭ transcranial magnetic stimulation; TR ϭ repetition time; VOI ϭ volumes of interest.Several genes have been identified that can lead to Parkinson disease (PD), including four recessively inherited forms caused by mutations in the Parkin (PARK2), DJ-1 (PARK7), PINK1 (PARK6), and ATP13A2 (PARK9) genes.1-3 These familial forms of PD show a substantial clinical overlap with sporadic PD. Nonmanifesting individuals who carry a single heterozygous mutation in the Parkin and PINK1 gene associated with recessively inherited PD