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01-01-2021 | Neurotomy | Original Communication

Cholinergic nucleus 4 atrophy and gait impairment in Parkinson’s disease

Authors: W. Alex Dalrymple, Diane S. Huss, Jamie Blair, Joseph L. Flanigan, James Patrie, Scott A. Sperling, Binit B. Shah, Madaline B. Harrison, T. Jason Druzgal, Matthew J. Barrett

Published in: Journal of Neurology | Issue 1/2021

Abstract

Background

There is evidence that cortical cholinergic denervation contributes to gait and balance impairment in Parkinson’s Disease (PD), especially reduced gait speed.

Objectives

The objective of this study was to determine the relationship between cholinergic basal forebrain gray matter density (GMD) and gait in PD patients.

Methods

We investigated 66 PD patients who underwent a pre-surgical evaluation for a neurosurgical procedure to treat motor symptoms of PD. As part of this evaluation patients had a brain MRI and formal gait assessments. By applying probabilistic maps of the cholinergic basal forebrain to voxel-based morphometry of brain MRI, we calculated gray matter density (GMD) for cholinergic nucleus 4 (Ch4), cholinergic nucleus 1, 2, and 3 (Ch123), and the entire cortex.

Results

Reduced Ch4 GMD was associated with reduced Fast Walking Speed in the “on” medication state (FWSON, p = 0.004). Bilateral cortical GMD was also associated with FWSON (p = 0.009), but Ch123 GMD was not (p = 0.1). Bilateral cortical GMD was not associated with FWSON after adjusting for Ch4 GMD (p = 0.44). While Ch4 GMD was not associated with improvement in Timed Up and Go (TUG) or Cognitive TUG in the “on” medication state, reduced Ch4 GMD was associated with greater percent worsening based on dual tasks (p = 0.021).

Conclusions

Reduced Ch4 GMD is associated with slower gait speed in PD and greater percent worsening in TUG during dual tasks in patients with PD. These findings have implications for planning of future clinical trials investigating cholinergic therapies to improve gait impairment in PD.

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Title: Cholinergic nucleus 4 atrophy and gait impairment in Parkinson’s disease
Authors: W. Alex Dalrymple
Diane S. Huss
Jamie Blair
Joseph L. Flanigan
James Patrie
Scott A. Sperling
Binit B. Shah
Madaline B. Harrison
T. Jason Druzgal
Matthew J. Barrett
Publication date: 01-01-2021
Publisher: Springer Berlin Heidelberg
Keywords: Neurotomy
Parkinson's Disease
Published in: Journal of Neurology / Issue 1/2021
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-020-10111-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Cholinergic nucleus 4 atrophy and gait impairment in Parkinson’s disease

Abstract

Background

Objectives

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objectives

Methods

Results

Conclusions

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