{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T09:33:51Z","timestamp":1790415231469,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T00:00:00Z","timestamp":1598227200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["5R00HD078492\u201004"],"award-info":[{"award-number":["5R00HD078492\u201004"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100013301","name":"Parkinson's Foundation","doi-asserted-by":"publisher","award":["PF\u2010FBS\u20101898"],"award-info":[{"award-number":["PF\u2010FBS\u20101898"]}],"id":[{"id":"10.13039\/100013301","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disorders"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Degradation of striatal dopamine in Parkinson's disease (PD) may initially be supplemented by increased cognitive control mediated by cholinergic mechanisms. Shift to cognitive control of walking can be quantified by prefrontal cortex activation. Levodopa improves certain aspects of gait and worsens others, and cholinergic augmentation influence on gait and prefrontal cortex activity remains unclear. This study examined dopaminergic and cholinergic influence on gait and prefrontal cortex activity while walking in PD. A single\u2010site, randomized, double\u2010blind crossover trial examined effects of levodopa and donepezil in PD. Twenty PD participants were randomized, and 19 completed the trial. Participants were randomized to either levodopa + donepezil (5\u2009mg) or levodopa + placebo treatments, with 2\u2009weeks with treatment and a 2\u2010week washout. The primary outcome was change in prefrontal cortex activity while walking, and secondary outcomes were change in gait and dual\u2010task performance and attention. Levodopa decreased prefrontal cortex activity compared with <jats:italic>off<\/jats:italic> medication (effect size, \u22120.51), whereas the addition of donepezil reversed this decrease. Gait speed and stride length under single\u2010 and dual\u2010task conditions improved with combined donepezil and levodopa compared with <jats:italic>off<\/jats:italic> medication (effect size, 1 for gait speed and 0.75 for stride length). Dual\u2010task reaction time was quicker with levodopa compared with <jats:italic>off<\/jats:italic> medication (effect size, \u22120.87), and accuracy improved with combined donepezil and levodopa (effect size, 0.47). Cholinergic therapy, specifically donepezil 5\u2009mg\/day for 2\u2009weeks, can alter prefrontal cortex activity when walking and improve secondary cognitive task accuracy and gait in PD. Further studies will investigate whether higher prefrontal cortex activity while walking is associated with gait changes. \u00a9 2020 International Parkinson and Movement Disorder Society<\/jats:p>","DOI":"10.1002\/mds.28214","type":"journal-article","created":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T15:53:24Z","timestamp":1598284404000},"page":"2019-2027","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Prefrontal Cortex Activity and Gait in Parkinson's Disease With Cholinergic and Dopaminergic Therapy"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6846-9372","authenticated-orcid":false,"given":"Samuel","family":"Stuart","sequence":"first","affiliation":[{"name":"Department of Neurology Oregon Health and Science University  Portland Oregon USA"},{"name":"Department of Sport, Exercise and Rehabilitation Northumbria University  Newcastle upon Tyne 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