title: Dual-task interference and brain structural connectivity in people with Parkinson's disease who freeze.
abstract: BACKGROUND
  Freezing of gait in people with Parkinson's disease (PD) is likely related to attentional control (ie, ability to divide and switch attention). However, the neural pathophysiology of altered attentional control in individuals with PD who freeze is unknown. Structural connectivity of the pedunculopontine nucleus has been related to freezing and may play a role in altered attentional control; however, this relationship has not been investigated. We measured whether dual-task interference, defined as the reduction in gait performance during dual-task walking, is more pronounced in individuals with PD who freeze, and whether dual-task interference is associated with structural connectivity and/or executive function in this population.
  
  
  METHODS
  We measured stride length in 13 people with PD with and 12 without freezing of gait during normal and dual-task walking. We also assessed asymmetry of pedunculopontine nucleus structural connectivity via diffusion tensor imaging and performance on cognitive tests assessing inhibition and set-shifting, cognitive domains related to freezing.
  
  
  RESULTS
  Although stride length was not different across groups, change in stride length between normal and dual-task gait (ie, dual-task interference) was more pronounced in people with PD who freeze compared to non-freezers. Further, in people with PD who freeze, dual-task interference was correlated with asymmetry of pedunculopontine nucleus structural connectivity, Go-NoGo target accuracy (ability to release a response) and simple reaction time.
  
  
  CONCLUSIONS
  These results support the hypothesis that freezing is related to altered attentional control during gait, and suggest that differences in pedunculopontine nucleus connectivity contribute to poorer attentional control in people with PD who freeze.
authors.affiliation: Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA Portland Veterans Affairs Medical Center, Portland, Oregon, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Peterson
authors.affiliation: Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA Portland Veterans Affairs Medical Center, Portland, Oregon, USA.
authors.forename: Brett W
authors.initials: BW
authors.lastname: Fling
authors.affiliation: Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Martina
authors.initials: M
authors.lastname: Mancini
authors.affiliation: Department of Psychology & Communication Studies, University of Idaho, Moscow, Idaho, USA.
authors.forename: Rajal G
authors.initials: RG
authors.lastname: Cohen
authors.affiliation: Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Nutt
authors.affiliation: Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA Portland Veterans Affairs Medical Center, Portland, Oregon, USA.
authors.forename: Fay B
authors.initials: FB
authors.lastname: Horak
mesh_terms: D000368:Aged; D001288:Attention / Q000502:physiology; D056324:Diffusion Tensor Imaging; D056344:Executive Function / Q000502:physiology*; D005684:Gait / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D009434:Neural Pathways / Q000473:pathology / Q000503:physiopathology*; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000473:pathology / Q000503:physiopathology*; D045042:Pedunculopontine Tegmental Nucleus / Q000473:pathology / Q000503:physiopathology*; D011597:Psychomotor Performance / Q000502:physiology*; D016138:Walking / Q000502:physiology*
keywords: ATTENTION; COGNITION; GAIT; PARKINSON'S DISEASE