Effect of Mental Imagery Training on Brain Plasticity and Motor Function in Individuals With Parkinson's Disease

Study Overview
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Brief Summary
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Effect of Mental Imagery Training on Brain Plasticity and Motor Function in Individuals with Parkinson's Disease: A functional MRI investigation.

Detailed Description
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This project will examine the effect of functional MRI-based neurofeedback on brain plasticity and motor performance in patients with Parkinson's Disease (PD).

Official Title
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Effect of Mental Imagery Training on Brain Plasticity and Motor Function in Individuals With Parkinson's Disease: A Functional MRI Investigation

Conditions
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Parkinson Disease

Intervention / Treatment
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* Other: PD neurofeedback
* Other: PD control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subjects with a diagnosis of idiopathic PD defined according to the UK Brain Bank diagnostic criteria and on a stable dopaminergic medication regimen will be included. Exclusion Criteria: Age < 40 years Non-English speaking Pregnancy Breastfeeding Excessive alcohol consumption (> 7 drinks per week for women, > 14 drinks per week for men) or substance use History of a neurological disorder such as a brain tumor, stroke, central nervous system infection, multiple sclerosis, movement disorder (other than PD), or seizures History of schizophrenia, bipolar disorder, attention deficit disorder, or obsessive compulsive disorder History of head injury with loss of consciousness Metallic surgical implants or traumatically implanted metallic foreign bodies Inability to lie flat for about an hour Discomfort being in small, enclosed spaces Dementia (Montreal Cognitive Assessment score < 21) Depression (Beck Depression Inventory-II score > 19) Hoehn & Yahr stage > 3 (i.e., able to stand and walk, but not fully independent) Focal neurological findings on exam that suggest cerebral pathology other than that associated with parkinsonism Motor symptoms that could potentially introduce too much motion artifact in the imaging data (e.g., MDS-UPDRS resting tremor score > 1 in limbs, head/chin tremor, or dyskinesia by history or exam).

Ages Eligible for Study
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Minimum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Patients with PD neurofeedback training<br>Patients will receive neurofeedback training. | Other: PD neurofeedback<br>* PD-neurofeedback subjects will practice motor imagery in the MRI scanner and receive neurofeedback on their performance. There will be a total of 10-12 neurofeedback sessions on two separate days. Subjects will continue practicing motor imagery at home every day throughout the study period for 4-6 weeks.<br>|
| Active Comparator: Patients with PD control<br>Patients will not receive neurofeedback training. | Other: PD control<br>* PD-control subjects will practice visual imagery (e.g., of scenery, objects, etc., but not of movement) in the MRI scanner and will not receive neurofeedback on their performance. Subjects will continue practicing visual imagery at home every day throughout the study period for 4-6 weeks.<br>|
| No Intervention: Patients with PD<br>Patients perform mental imagery (motor and visual aspects combined) in the MRI scanner without neurofeedback training. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Right Insula-dorsomedial Frontal Cortex Functional Connectivity Strength. | The functional connectivity strength between the subjects' right insula and dorsomedial frontal cortex will be measured at baseline and post-intervention as each group of subjects engages in their respective imagery tasks. Functional connectivity will be measured as the correlation value between the functional MRI signal time courses obtained from these two brain regions. | 4-6 weeks | 
| Change in Resting-state Functional Connectivity Between the Right Insula and Dorsomedial Frontal Cortex. | We will obtain resting-state functional MRI scans from the PD-neurofeedback and PD-control groups at baseline and post-intervention to examine the changes in intrinsic functional connectivity between the right insula and dorsomedial frontal cortex. Functional connectivity will be measured as the correlation value between the functional MRI signal time courses obtained from these two brain regions. | 4-6 weeks | 
| Change in Motor Impairment | We will administer the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III (motor exam) at baseline and post-intervention to the PD-neurofeedback and PD-control groups to measure the change in motor impairment. The MDS-UPDRS part III is a subscale that provides an objective assessment of motor impairment. The scores range between 0-132. Higher scores indicate more severe impairment. | Baseline and 4-6 weeks | 
| Change in Motor Function | We will administer standard motor function tests (e.g., timed up and go, 5 times sit-to-stand, 360-degree turn) at baseline and post-intervention to the PD-neurofeedback and PD-control groups to measure the change in motor function. The performance score on these tests is the time to complete the motor tasks. Shorter time indicates better performance. The motor function tests measure movement speed. Timed up and go test measures (seconds) how fast one can stand up from a chair, walk 3 meters, turn, walk back to the chair and sit down again. Five times sit-to-stand test measures (seconds) how fast one can stand up from a chair with arms crossed across the chest and sit back again 5 times in a row. 360-degree turn test measures (seconds) how fast one can turn around their own axis clockwise and counterclockwise. The composite motor function score is the sum of the durations (seconds) of all three tests. | Baseline and 4-6 weeks |