Journal of Movement Disorders

Original Articles

Cognitive Impairment Alters Cortical Adaptation and Gait Regulation During Obstacle Walking in Parkinson’s Disease: Evidence from Temporal fNIRS and Gait Dynamics: Pei-Ling Wong, Yea-Ru Yang, Chen-Wei Hung, Nai-Chen Yeh, Shih-Jung Cheng, Ray-Yau Wang; Received December 25, 2025 Accepted March 3, 2026 Published online March 3, 2026; DOI: https://doi.org/10.14802/jmd.25346 [Accepted]

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Abstract PDF: Background
Obstacle crossing during walking poses a major fall risk in individuals with Parkinson’s disease (PD), particularly those with cognitive impairment. Although cognitive decline worsens gait, its specific effects on gait performance and cortical activation during obstacle walking remain unclear. The dynamic interaction between brain activity and gait across different walking phases is especially understudied in PD with mild cognitive impairment (PD-MCI) compared to those without cognitive impairment (PD-nonMCI).
Methods
Nineteen PD-nonMCI and fifteen PD-MCI participants performed obstacle walking while functional near-infrared spectroscopy (fNIRS) measured activation in the prefrontal cortex (PFC), supplementary motor area (SMA), and premotor cortex (PMC). Gait parameters (speed, cadence, stride length, stride time) and obstacle crossing metrics (crossing speed, stride length, stride time, step width) were analyzed across early (5–20 s) and late (20–40 s) phases. Generalized estimating equations examined group, phase, and interaction effects. Brain–gait associations were assessed using Spearman’s correlations.
Results
PD-MCI participants exhibited poorer obstacle walking performance but no significant phase-related behavioral change. Both groups showed higher PFC, SMA, and PMC activation during the early phase, reflecting greater neural engagement at task onset. However, SMA and PMC activation declined more steeply across phases in the PD-MCI group. In PD-MCI, obstacle walking performance correlated negatively with early-phase PMC and late-phase PFC activation.
Conclusions
PD-MCI participants showed poorer gait and higher cortical activation, indicating increased neural effort and reduced efficiency. These results highlight altered brain–gait coupling in PD-MCI and emphasize the need for interventions enhancing neural efficiency during complex walking.

Retro-Walking and Cholinergic Network Correlates in Parkinson’s Disease: Alexis Griggs, Giulia Carli, Taylor Brown, Prabesh Kanel, Stiven Roytman, Chatkaew Pongmala, Miriam van Emde Boas, Nicolaas Ida Bohnen; J Mov Disord. 2025;18(4):337-346. Published online July 30, 2025; DOI: https://doi.org/10.14802/jmd.25109

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Abstract PDF: Objective
To investigate the cholinergic underpinnings of forward and retro-walking in patients with Parkinson’s disease (PwP) using [¹⁸F]fluoroethoxybenzovesamicol ([¹⁸F]FEOBV) positron emission tomography (PET), which binds to the vesicular acetylcholine transporter.
Methods
We retrospectively included 44 PwP who underwent [¹⁸F]FEOBV PET imaging and forward- and retro-walking gait assessments. Voxelwise correlation analyses were performed to examine associations between gait velocities and [¹⁸F]FEOBV binding, controlling for levodopa equivalent dose and disease duration. Linear regression and mediation analyses were used to investigate the contribution of postural instability and gait disorder symptoms—measured using MDS-UPDRS items and the Mini-Balance Evaluation Systems Test (MiniBESTest)—as well as cognitive performance (attention, memory, executive, language, and visuospatial domains) to the observed associations.
Results
Slower retro-walking velocity was associated with lower [¹⁸F]FEOBV uptake in a subcortical–frontal–temporal cluster, including the bilateral middle frontal cortex, anterior cingulate, insula, basal forebrain, and striatal regions. No significant associations were found for forward walking time. Linear regression analyses revealed that MiniBESTest total score, reactive postural control subscore, and attention domain score were associated with both cholinergic uptake in the identified cluster and retro-walking velocities. Mediation analyses revealed that attention and reactive postural control mediated the relationship between [¹⁸F]FEOBV binding and retro-walking performance.
Conclusion
Our findings indicate that retro-walking places greater demands on brain cholinergic synaptic integrity involving subcortical-frontal and temporal cortical regions, subserving balance—particularly reactive postural control—and attentional resources compared to forward walking. Our results suggest that retro-walking might serve as part of an intervention strategy to improve balance and cognition in PwP.

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