Background Walking abnormalities in people with Parkinson’s disease (PD) are characterized by a shift in locomotor control from healthy automaticity to compensatory prefrontal executive control. Indirect measures of automaticity of walking (eg, step-to-step variability and dual-task cost) suggest that freezing of gait (FoG) may be associated with reduced automaticity of walking. However, the influence of FoG status on actual prefrontal cortex (PFC) activity during walking remains unclear. Objective To investigate the influence of FoG status on automaticity of walking in people with PD. Methods Forty-seven people with PD were distributed into 2 groups based on FoG status, which was assessed by the New Freezing of Gait Questionnaire: PD−FoG (n = 23; UPDRS-III = 35) and PD+FoG (n = 24; UPDRS-III = 43.1). Participants walked over a 9-m straight path (with a 180° turn at each end) for 80 seconds. Two conditions were tested off medication: single- and dual-task walking (ie, with a concomitant cognitive task). A portable functional near-infrared spectroscopy system recorded PFC activity while walking (including turns). Wearable inertial sensors were used to calculate spatiotemporal gait parameters. Results PD+FoG had greater PFC activation during both single and dual-task walking than PD−FoG (P = .031). There were no differences in gait between PD−FoG and PD+FoG. Both groups decreased gait speed (P = .029) and stride length (P < .001) during dual-task walking compared with single-task walking. Conclusions These findings suggest that PD+FoG have reduced automaticity of walking, even in absence of FoG episodes. PFC activity while walking seems to be more sensitive than gait measures in identifying reduction in automaticity of walking in PD+FoG.

中文翻译：

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帕金森病患者步态冻结的执行控制

背景 帕金森病 (PD) 患者的步行异常的特征是运动控制从健康的自动性转变为补偿性前额叶执行控制。步行自动性的间接测量（例如，步进变异性和双任务成本）表明步态冻结 (FoG) 可能与步行自动性降低有关。然而，步行期间 FoG 状态对实际前额叶皮层 (PFC) 活动的影响仍不清楚。目的探讨FoG状态对PD患者行走自控能力的影响。方法 将 47 名 PD 患者根据 FoG 状态分为两组，通过 New Freezing of Gait Questionnaire 进行评估：PD-FoG（n = 23；UPDRS-III = 35）和 PD+FoG（n = 24 ；UPDRS-III = 43.1)。参与者在一条 9 米的直线路径上行走（每端转 180 度）80 秒。对两种情况进行了药物测试：单任务和双任务步行（即伴随认知任务）。便携式功能性近红外光谱系统记录步行（包括转弯）时的 PFC 活动。可穿戴惯性传感器用于计算时空步态参数。结果 与 PD-FoG 相比，PD+FoG 在单任务和双任务行走期间的 PFC 激活程度更高（P = .031）。PD-FoG 和 PD+FoG 之间的步态没有差异。与单任务步行相比，两组在双任务步行期间的步态速度（P = .029）和步幅（P < .001）均降低。结论 这些发现表明，即使没有 FoG 发作，PD+FoG 也降低了步行的自动性。