Neuroplasticity and balance training in Parkinson’s disease: planned analysis of a randomized controlled trial

Abstract

Parkinson’s disease (PD) is a neurodegenerative disease mainly characterized by motor symptoms such as muscle stiffness, movement difficulties, and clumsiness. There is no cure for PD yet, thus alternative treatments ensuring quality of life are needed. Neuroplasticity - a possible inhibition of degenerative processes - in response to physical exercise would decrease the diseases’ burden. Indeed, intensive, challenging, and cognitively demanding physical exercise induces neuroplasticity in PD. Recently, we have shown by a highly challenging balance training (HiBalance program) positive effects on gait and balance. In the present study we aim to link behavioral changes to neuroplastic brain alterations. Effects of this highly challenging balance training on brain structure and functional connectivity and motor-cognitive functions will be investigated. We will address the questions of how much does baseline brain structure and connectivity differ. Further, we research if plastic changes occur after the intervention and their correlation with motor-cognitive improvement. Thirty-nine healthy controls and 83 idiopathic PD patients (Hoehn&Yahr 2-3, ≧60 yrs, ≧21 MoCA) were recruited. PD patients were randomly assigned to either an active control group or the HiBalance program. The HiBalance program took place twice a week for a 1h over 10 weeks. Balance (Mini-BESTest) and temporal/spatial gait parameters (GAITRite) were evaluated pre- and post-completion of the program. Structural and resting-state magnetic resonance imaging (MRI,3T Phillips Ingenia) were obtained from patients pre- and post the program. Healthy controls underwent MRI as well as balance and gait assessment. Voxel-based and surface-based morphometry will be applied using CAT12 to investigate structural alterations related to the program. Connectivity changes will be assessed by eigenvector centrality mapping in the whole-brain using LIPSIA and atlas-based selective connectivity using BRAPH. Correlations with balance and gait parameters will be carried out in SPM12. Results will change treatment and increase quality of life in PD patients.