Nigrostriatal dopaminergic integrity in relation to prefrontal cortex activity and gait performance during dual-task walking in older adults

Background Walking automaticity facilitates maintenance of gait speed without prefrontal cortex (PFC) resources. Brain aging may cause shifts to attentional gait with greater engagement of the PFC. Nigrostriatal dopaminergic integrity likely facilitates walking automaticity and gait speed during attentional dual-tasks. Methods Older adults (n = 201; age = 74.9; 63.2% women, gait speed = 1.10 m/s) completed a dual-task protocol of saying every other letter of the alphabet while walking. PFC activation was measured by functional near-infrared spectroscopy. Four groups were defined based on PFC activation (increased during dual-task, PFC+, or not, PFC-) and gait speed performance (maintained during dual-task, gait+, or slowed, gait-). To compare nigrostriatal dopaminergic integrity across groups, we assessed binding of the type-2 vesicular monoamine transporter density in the sensorimotor and associative striatum using [¹¹C]-(+)-a-dihydrotetrabenazine (DTBZ) positron emission tomography. Multinomial regression estimated adjusted associations of DTBZ binding with group membership. We hypothesized that DTBZ binding was highest for those who maintained gait speed without additional PFC activation when switching from single- to dual-task (PFC-/gait+; ie, highest gait automaticity). Results In bivariate analyses, the PFC-/gait+ group had the highest DTBZ binding in the sensorimotor striatum (P =. 05); binding in the associative striatum was similar across groups (P =. 1). Results were similar in adjusted regression analyses; DTBZ binding in sensorimotor striatum was associated with lower likelihood to be in the PFC-/gait- (odds ratio [OR] = 0.28; 95% CI, 0.08-0.94) or the PFC+/gait+ (OR = 0.29; 95% CI, 0.10-0.84) groups compared to PFC-/gait+ reference group. Conclusion These results provide support for dopaminergic involvement in sustaining gait automaticity at older ages.