Leocadi, M; Canu, E; Sarasso, E; Gardoni, A; Basaia, S; Calderaro, D; Castelnovo, V; ... Agosta, F; + view all Leocadi, M; Canu, E; Sarasso, E; Gardoni, A; Basaia, S; Calderaro, D; Castelnovo, V; Volontè, MA; Filippi, M; Agosta, F; - view fewer (2024) Dual-task gait training improves cognition and resting-state functional connectivity in Parkinson’s disease with postural instability and gait disorders. Journal of Neurology , 271 pp. 2031-2041. 10.1007/s00415-023-12151-w.

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Abstract

Objectives To assess whether dual-task gait/balance training with action observation training (AOT) and motor imagery (MI) ameliorates cognitive performance and resting-state (RS) brain functional connectivity (FC) in Parkinson’s disease (PD) patients with postural instability and gait disorders (PIGD). Methods 21 PD-PIGD patients were randomized into 2 groups: (1) DUAL-TASK + AOT-MI group performed a 6-week training consisting of AOT-MI combined with practicing observed-imagined gait and balance exercises; and (2) DUAL-TASK group performed the same exercises combined with landscape-videos observation. At baseline and after training, all patients underwent a computerized cognitive assessment, while 17 patients had also RS-fMRI scans. Cognitive and RS-FC changes (and their relationships) over time within and between groups were assessed. Results After training, all PD-PIGD patients improved accuracy in a test assessing executive–attentive (mainly dual-task) skills. DUAL-TASK + AOT-MI patients showed increased RS-FC within the anterior salience network (aSAL), and reduced RS-FC within the anterior default mode network (aDMN), right executive control network and precuneus network. DUAL-TASK patients showed increased RS-FC within the visuospatial network, only. Group × Time interaction showed that, compared to DUAL-TASK group, DUAL-TASK + AOT-MI cases had reduced RS-FC within the aDMN, which correlated with higher accuracy in a dual-task executive–attentive test. Conclusions In PD-PIGD patients, both trainings promote cognitive improvement and brain functional reorganization. DUAL-TASK + AOT-MI training induced specific functional reorganization changes of extra-motor brain networks, which were related with improvement in dual-task performance.

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