Attention to action in Parkinson's disease: impaired effective connectivity among frontal cortical regions.

The neural basis of attention to action was studied in 12 patients with Parkinson's disease (Hoehn and Yahr grades II and III) and 12 healthy age-matched controls. The subjects were studied by functional MRI (fMRI) during performance of a simple paced overlearned motor sequence task, with and without an additional attentional task. For the attentional task, subjects were instructed to attend either to their actions or to a visual distractor task. Statistical parametric mapping was used to implement a random effects analysis of the regional task-related activations in patient and control populations. Structural equation modelling of fMRI time series was used to measure effective connectivity among prefrontal and premotor areas. In both groups, the motor task was associated with activation of a distributed network including the premotor, motor and parietal cortex, striatum and cerebellum. In control subjects, but not patients, attention to action (relative to execution of an overlearned sequence) was associated with further activation of prefrontal, parietal and paracingulate cortex, and the supplementary motor area (SMA). Patients with Parkinson's disease showed greater than normal activation of the SMA during execution of the simple overlearned motor sequence, but less augmentation when attending to their actions. In control subjects, attention to action, but not attention to the visual distractor task, increased the effective connectivity between prefrontal cortex and both the lateral premotor cortex and the SMA. This represents a specific increase in effective connectivity. Attentional modulation of effective connectivity between the prefrontal, premotor cortex and SMA was not observed in patients. This deficit indicates a context-specific functional disconnection between the prefrontal cortex and the supplementary and premotor cortex in Parkinson's disease.