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Changes in oxygenated hemoglobin link freezing of gait to frontal activation in patients with Parkinson disease: an fNIRS study of transient motor-cognitive failures

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Abstract

Recent studies have suggested that deficits in executive function contribute to freezing of gait (FOG), an episodic disturbance common among patients with Parkinson’s disease (PD). To date, most findings provide only indirect evidence of this relationship. Here, we evaluated a more direct link between FOG and frontal lobe dysfunction. Functional, near infrared spectroscopy measured frontal activation, i.e., oxygenated hemoglobin (HbO2) levels in Brodmann area 10 before and during FOG. Eleven patients with PD and eleven healthy older adults were studied. Changes in frontal lobe activation before and during FOG that occurred during turns were determined. Altogether, 49 FOG episodes were observed—28 occurred during turns that were anticipated (i.e., the patient knew in advance that the turn was coming), 21 during unanticipated turns that were performed “abruptly”, according to the examiner’s request. During anticipated turns, HbO2 increased by 0.22 ± 0.08 µM (p = 0.004) before FOG and by an additional 0.19 ± 0.13 µM (p = 0.072) during FOG. In contrast, during unanticipated turns, HbO2 did not increase before or during FOG. HbO2 decreased by 0.32 ± 0.08 µM (p = 0.004) during turns without FOG; in healthy controls HbO2 did not change during turns. These findings support the existence of an association between FOG episodes and changes in frontal lobe HbO2. Increased activation in Brodmann area 10 before FOG, specifically during anticipated turns, highlights the connections between motor planning, information processing, and FOG. These results support the idea that alterations in executive control play a role in this debilitating motor disturbance.

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Acknowledgments

This study was supported in part by European Union—Seventh Framework Programme (FP7-HEALTH-2011) under Grant agreement n. 278169 (V-TIME) and Grant agreement n. 288586 (CuPiD Project).

Conflicts of interest

On behalf of all the authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Center for the study of Movement, Cognition and Mobility, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel

    Inbal Maidan, Hagar Bernad-Elazari, Eran Gazit, Nir Giladi, Jeffery M. Hausdorff & Anat Mirelman

  2. Rivers Lab, Department of Rehabilitation and Movement Science, Rutgers Biomedical and Health Sciences, Newark, USA

    Inbal Maidan

  3. Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel

    Nir Giladi & Jeffery M. Hausdorff

  4. Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Nir Giladi

  5. Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Jeffery M. Hausdorff

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  1. Inbal Maidan
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  2. Hagar Bernad-Elazari
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  3. Eran Gazit
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Correspondence to Anat Mirelman.

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Maidan, I., Bernad-Elazari, H., Gazit, E. et al. Changes in oxygenated hemoglobin link freezing of gait to frontal activation in patients with Parkinson disease: an fNIRS study of transient motor-cognitive failures. J Neurol 262, 899–908 (2015). https://doi.org/10.1007/s00415-015-7650-6

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  • DOI: https://doi.org/10.1007/s00415-015-7650-6

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