Levodopa Facilitates Prefrontal Cortex Activation During Dual Task Walking in Parkinson Disease

Background: Although dopaminergic medication improves dual task walking in people with Parkinson disease (PD), the underlying neural mechanisms are not yet fully understood. As prefrontal cognitive resources are involved in dual task walking, evaluation of the prefrontal cortex (PFC) is required.                Objective: To investigate the effect of dopaminergic medication on PFC activity and gait parameters during dual task walking in people with PD. Methods. A total of 20 individuals with PD (69.8 ± 5.9 years) and 30 healthy older people (68.0 ± 5.6 years) performed 2 walking conditions: single and dual task (walking while performing a digit vigilance task). A mobile functional near infrared spectroscopy system and an electronic sensor carpet were used to analyze PFC activation and gait parameters, respectively. Relative concentrations of oxygenated hemoglobin (HbO₂) from the left and right PFC were measured. Results: People with PD in the off state did not present changes in HbO₂ level in the left PFC across walking conditions. In contrast, in the on state, they presented increased HbO₂ levels during dual task compared with single task. Regardless of medication state, people with PD presented increased HbO₂ levels in the right PFC during dual task walking compared with single task. The control group demonstrated increased PFC activity in both hemispheres during dual task compared with single task. People with PD showed increases in both step length and velocity in the on state compared with the off state.                    Conclusions: PD limits the activation of the left PFC during dual task walking, and dopaminergic medication facilitates its recruitment.