Effects of gait training on structural brain changes in Parkinson’s disease

Article type: Research Article

Authors: Kim, Eunkyung^{a; b} | Kim, Heejae^a | Yun, Seo Jung^a | Kang, Min-Gu^a | Shin, Hyun Iee^c | Oh, Byung-Mo^{a; d} | Seo, Han Gil^{a; *}

Affiliations: [a] Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea | [b] Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea | [c] Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Republic of Korea | [d] National Traffic Injury Rehabilitation Hospital, Yangpyeong, Republic of Korea

Correspondence: [*] Corresponding author: Han Gil Seo, MD, PhD Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea. Tel.: + 82 2 2072 1659; Fax: + 82 2 6072 5244; E-mail: [email protected].

Abstract: Background:Gait training may lead to functional brain changes in Parkinson’s disease (PD); however, there is a lack of studies investigating structural brain changes after gait training in PD. Objective:To investigate structural brain changes induced by 4 weeks of gait training in individuals with PD. Methods:Diffusion tensor imaging and structural T1 images were acquired in PD group before and after robot-assisted gait training or treadmill training, and in healthy control group. Tract-based spatial statistics and tensor-based morphometry were conducted to analyze the data. The outcome of gait training was assessed by gait speed and dual-task interference of cognitive or physical tests of the 10-meter walking test representing gait automaticity. The associations between structural brain changes and these outcomes were investigated using correlation analysis. Results:A total of 31 individuals with PD (68.5±8.7 years, the Hoehn & Yahr stage of 2.5 or 3) and 28 healthy controls (66.6±8.8 years) participated in this study. Compared to the controls, PD group at baseline showed a significant increased fractional anisotropy (FA) in the right forceps minor and bilateral brainstem and reduced radial diffusivity (RD) in the right superior longitudinal fasciculus, as well as the expanded structural volumes in the several brain areas. After gait training, FA increased in the left internal capsule and it decreased in the left cerebellum Crus I, while the structural volume did not change. The increased FA in the left internal capsule positively correlated with the baseline gait speed and negatively correlated with gait speed improvement; moreover, the decreased FA in the left cerebellum Crus I negatively correlated with the baseline gait speed during the cognitive task. Conclusions:Gait training induces white matter changes in the brain of individuals with PD, which suggests the improvement of brain structural pathology to mitigate the impact of neurodegenerative consequences.

Keywords: Parkinson’s disease, diffusion tensor imaging, brain plasticity, follow-up studies, intervention study, magnetic resonance imaging

DOI: 10.3233/RNN-221295

Journal: Restorative Neurology and Neuroscience, vol. 40, no. 4-6, pp. 271-288, 2022