Céline Tard1, Kathy Dujardin1, Jean-Louis Bourriez2, Alain Destée3, Philippe Derambure4, Luc Defebvre1, Arnaud Delval5. 1. Université Lille Nord de France, UDSL, France; Troubles cognitifs dégénératifs et vasculaires, EA1046, Lille 2, France; Neurology and Movement Disorders Department, Lille University Medical Center, France. 2. Troubles cognitifs dégénératifs et vasculaires, EA1046, Lille 2, France; Clinical Neurophysiology Department, Lille University Medical Center, France. 3. Université Lille Nord de France, UDSL, France; Neurology and Movement Disorders Department, Lille University Medical Center, France. 4. Université Lille Nord de France, UDSL, France; Troubles cognitifs dégénératifs et vasculaires, EA1046, Lille 2, France; Clinical Neurophysiology Department, Lille University Medical Center, France. 5. Université Lille Nord de France, UDSL, France; Troubles cognitifs dégénératifs et vasculaires, EA1046, Lille 2, France; Clinical Neurophysiology Department, Lille University Medical Center, France. Electronic address: arnaud.delval@chru-lille.fr.
Abstract
BACKGROUND: In view of freezing of gait's circumstances of occurrence in Parkinson's disease, attentional resources appear to be involved in step initiation failure. Anticipatory postural adjustments (APAs) are essential because they allow unloading of the stepping leg and so create the conditions required for progression. Our main objective was to establish whether or not a change in attentional load during step initiation modulates APAs differently in patients with vs. without freezing of gait. METHODS: Three groups of 15 subjects were recruited: elderly people and parkinsonian patients with or without freezing of gait. Attention was modulated before step execution by means of an auditory oddball discrimination task with event-related potential recording. The primary endpoint was the occurrence of inappropriate APAs following the attentional task, i.e. APAs not followed by a step after an intercurrent auditory stimulus. RESULTS: In parkinsonian patients with freezing of gait, inappropriate APAs were recorded in 63% of the trials and were observed more frequently than in patients without freezing of gait (51%) and elderly controls (48%). Furthermore, inappropriate APAs in freezers were longer and more ample than in parkinsonian non-freezers and controls. Lastly, postural preparation was impaired in the parkinsonian patients. CONCLUSION: Our results indicate that allocation of attentional resources during step preparation influences the release of APAs differently in freezers and non-freezers. Modulating attentional load is partly responsible for triggering an inappropriate motor program. This difficulty in focusing attention or resisting interference may contribute (at least in part) to the gait initiation failure observed in parkinsonian freezers.
RCT Entities:
BACKGROUND: In view of freezing of gait's circumstances of occurrence in Parkinson's disease, attentional resources appear to be involved in step initiation failure. Anticipatory postural adjustments (APAs) are essential because they allow unloading of the stepping leg and so create the conditions required for progression. Our main objective was to establish whether or not a change in attentional load during step initiation modulates APAs differently in patients with vs. without freezing of gait. METHODS: Three groups of 15 subjects were recruited: elderly people and parkinsonianpatients with or without freezing of gait. Attention was modulated before step execution by means of an auditory oddball discrimination task with event-related potential recording. The primary endpoint was the occurrence of inappropriate APAs following the attentional task, i.e. APAs not followed by a step after an intercurrent auditory stimulus. RESULTS: In parkinsonianpatients with freezing of gait, inappropriate APAs were recorded in 63% of the trials and were observed more frequently than in patients without freezing of gait (51%) and elderly controls (48%). Furthermore, inappropriate APAs in freezers were longer and more ample than in parkinsonian non-freezers and controls. Lastly, postural preparation was impaired in the parkinsonianpatients. CONCLUSION: Our results indicate that allocation of attentional resources during step preparation influences the release of APAs differently in freezers and non-freezers. Modulating attentional load is partly responsible for triggering an inappropriate motor program. This difficulty in focusing attention or resisting interference may contribute (at least in part) to the gait initiation failure observed in parkinsonian freezers.
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