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Brain Advance Access originally published online on November 21, 2006
Brain 2007 130(1):233-244; doi:10.1093/brain/awl326
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© The Author (2006). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Cortical activity in Parkinson's disease during executive processing depends on striatal involvement

Oury Monchi1,2, Michael Petrides3, Beatriz Mejia-Constain1,2 and Antonio P. Strafella3,4

1 Functional Neuroimaging Unit, Research Centre, Institut Universitaire de Gériatrie de Montréal Montreal, Quebec 2 Department of Radiology, Université de Montréal Montreal, Quebec 3 Montreal Neurological Institute, McGill University Montreal, Quebec 4 UNH-Toronto Western Hospital and CAMH-PET Imaging Center, University of Toronto, Toronto Ontario, Canada

Correspondence to: Oury Monchi, PhD, Centre de recherche, Institut Universitaire de Gériatrie de Montréal, 4565 Queen Mary Road, Montreal, H3W 1W5, QC, Canada E-mail: oury.monchi{at}umontreal.ca

Patients with idiopathic Parkinson's disease exhibit impairments in executive processes, including planning and set-shifting, even at the early stages of the disease. We have recently developed a new card-sorting task to study the specific role of the caudate nucleus in such executive processes and have shown, using functional magnetic resonance imaging (fMRI) in young healthy adults, that the caudate nucleus is specifically required when a set-shift must be planned. Here the same fMRI protocol was used to compare the patterns of activation in a group of early-stage Parkinson's disease patients (seven right-handed patients at Hoehn and Yahr stages 1 and 2; mean age 62 years, range 56–70) and matched control subjects. Increased cortical activation was observed in the patients compared with the control group in the condition not specifically requiring the caudate nucleus. On the other hand, decreased cortical activation was observed in the patient group in the condition significantly involving the caudate nucleus. This event-related fMRI study showed a pattern of cortical activation in Parkinson's disease characterized by either reduced or increased activation depending on whether the caudate nucleus was involved or not in the task. This activation pattern included not only the prefrontal regions but also posterior cortical areas in the parietal and prestriate cortex. These findings are not in agreement with the traditional model, which proposes that the nigrostriatal dopamine depletion results in decreased cortical activity. These observations provide further evidence in favour of the hypothesis that not only the nigrostriatal and but also the mesocortical dopaminergic substrate may play a significant role in the cognitive deficits observed in Parkinson's disease.

Key Words: executive functions; fMRI; Parkinson's disease; set-shifting; striatum

Abbreviations: DA, dopamine; fMRI, functional magnetic resonance imaging; MCST, Montreal Card-Sorting Task; PFC, prefrontal cortex

Received May 4, 2006. Revised September 11, 2006. Accepted October 19, 2006.


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