Dysfunctional limbic circuitry underlying freezing of gait in Parkinson's disease

Moran Gilat*, Kaylena A. Ehgoetz Martens, Oscar Miranda-Domínguez, Ishu Arpan, James M. Shine, Martina Mancini, Damien A. Fair, Simon J. G. Lewis, Fay B. Horak

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

88 Citations (Scopus)


Freezing of gait (FOG) is a poorly understood symptom affecting many patients with Parkinson's disease (PD). Despite growing evidence of a behavioral link between anxiety, attention and FOG in PD, no research to date has investigated the neural mechanisms that might explain this relationship. The present study therefore examined resting-state MRI functional connectivity between the amygdala, striatum and frontoparietal attentional control network in PD patients with (freezers: n = 19) and without FOG (non-freezers: n = 21) in the dopaminergic ‘off’ state. Functional connectivity was subsequently correlated with an objective measure of FOG severity and a subjective scale of affective disorder within each group. Connectivity between the right amygdala and right putamen was significantly increased in freezers compared to non-freezers (p < 0.01). Furthermore, freezers showed increased anti-coupling between the frontoparietal network and left amygdala (p = 0.011), but reduced anti-coupling between this network and the right putamen (p = 0.027) as compared to non-freezers. Key functional connections between the amygdala, putamen and frontoparietal network were significantly associated with FOG severity and a fear of falling. This study provides the first evidence that dysfunctional fronto-striato-limbic processes may underpin the link between anxiety and FOG in PD. It is proposed that freezers have heightened striato-limbic load and reduced top-down attentional control at rest, which when further challenged by the parallel processing demands of walking may precipitate FOG.

Original languageEnglish
Pages (from-to)119-132
Number of pages14
Publication statusPublished - 15 Mar 2018
Externally publishedYes


  • amygdala
  • anxiety
  • functional MRI
  • gait disorders
  • Parkinson's disease
  • putamen


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