Retro-Walking and Cholinergic Network Correlates in Parkinson's Disease
Alexis Griggs1,2, Giulia Carli2,3, Taylor Brown1,2,4
1University of Michigan Department of Radiology, Ann Arbor, MI, USA.
Journal of Movement Disorders
|July 30, 2025
Summary
Retro-walking in Parkinson's disease is linked to reduced vesicular acetylcholine transporter (VAChT) binding, particularly in brain regions supporting balance and attention. These findings suggest retro-walking may improve balance and cognition in PD patients.
Area of Science:
- Neuroscience
- Neurology
- Radiochemistry
Background:
- Parkinson's disease (PD) is a neurodegenerative disorder affecting motor control, including gait.
- Cholinergic pathways, involving the vesicular acetylcholine transporter (VAChT), are implicated in motor function and cognition.
- Gait disturbances in PD are complex, with forward and backward walking potentially relying on different neural mechanisms.
Purpose of the Study:
- To investigate the role of the cholinergic system in forward and retro-walking in Parkinson's disease.
- To examine the association between vesicular acetylcholine transporter (VAChT) availability and gait performance using [18F]FEOBV Positron Emission Tomography (PET).
Main Methods:
- Retrospective analysis of 44 Parkinson's disease patients undergoing [18F]FEOBV PET scans and gait assessments.
- Voxel-wise correlation analyses between gait velocities and [18F]FEOBV uptake, controlling for medication and disease duration.
- Linear regression and mediation analyses incorporating postural instability and gait disorder (PIGD) symptoms and cognitive function.
Main Results:
- Slower retro-walking velocity correlated with lower [18F]FEOBV uptake in a cluster including frontal, cingulate, insula, basal forebrain, and striatal regions.
- No significant association was found between [18F]FEOBV uptake and forward walking velocity.
- Mini-Balance Evaluation Systems Test (MiniBESTest) scores (total and reactive postural control) and attention domain scores were linked to both cholinergic uptake and retro-walking velocity.
Conclusions:
- Retro-walking in Parkinson's disease is more demanding on balance, particularly reactive postural control, and attentional resources compared to forward walking.
- Attention and reactive postural control mediate the relationship between cholinergic system integrity and retro-walking performance.
- Retro-walking may hold potential as an intervention strategy to enhance balance and cognitive function in individuals with Parkinson's disease.
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