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Fall risk is associated with amplified functional connectivity of the central executive network in patients with Parkinson’s disease

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Abstract

Falls are debilitating problems that markedly impact the health-related quality of life of many patients with Parkinson’s disease (PD). Numerous studies point to the role of executive function and attention in falls; however, the brain mechanisms underlying these relationships are less clear. Here, we aim to evaluate the brain mechanisms underlying the role of executive function in falls. Patients with PD who were fallers (n = 27) or non-fallers (n = 53) and 27 healthy older adults were examined in a cross-sectional study. Gray matter volumes of the caudate head and posterior putamen were evaluated, as these striatal regions play a role in the executive and the sensorimotor cortico-striatal networks, respectively. The functional connectivity of the central executive network and of the sensorimotor network was measured using intrinsic brain connectivity during resting state functional magnetic resonance imaging. Compared to non-fallers and healthy controls, fallers had lower gray matter volume in the caudate head, but not in the posterior putamen, and increased connectivity between posterior partial regions of the central executive network, with no difference within the sensorimotor network. Mediation analysis demonstrated that the relationships between caudate head gray matter volume and fall history and risk were mediated by increased connectivity within the central executive network, apparently via attentional changes. The above findings provide additional converging evidence for the involvement of executive-related brain changes in falls in PD and support the important role of attention and executive function in fall risk.

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Acknowledgments

We are grateful to all the patients who participated in this study. We thank Marina Brozgol, Inbal Maidan and Moran Dorfman from the Center for the study of Movement, Cognition, and Mobility for their help in clinical evaluation. This research was supported in part by the Michael J. Fox Foundation for Parkinson’s Research.

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Authors and Affiliations

  1. Department of Neurology, Center for the Study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel

    Keren Rosenberg-Katz, Talia Herman, Yael Jacob, Anat Mirelman, Nir Giladi & Jeffrey M. Hausdorff

  2. Functional Brain Center, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Keren Rosenberg-Katz, Yael Jacob & Talma Hendler

  3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Talia Herman, Nir Giladi & Talma Hendler

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

    Jeffrey M. Hausdorff

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

    Yael Jacob, Nir Giladi, Talma Hendler & Jeffrey M. Hausdorff

  6. The School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel

    Talma Hendler

  7. Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Nir Giladi

Authors
  1. Keren Rosenberg-Katz
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  2. Talia Herman
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  3. Yael Jacob
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  4. Anat Mirelman
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  5. Nir Giladi
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  6. Talma Hendler
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  7. Jeffrey M. Hausdorff
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Corresponding author

Correspondence to Jeffrey M. Hausdorff.

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

Ethical standard

The study was approved by the local human studies committee and all subjects provided informated written consent.

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Rosenberg-Katz, K., Herman, T., Jacob, Y. et al. Fall risk is associated with amplified functional connectivity of the central executive network in patients with Parkinson’s disease. J Neurol 262, 2448–2456 (2015). https://doi.org/10.1007/s00415-015-7865-6

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  • DOI: https://doi.org/10.1007/s00415-015-7865-6

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