Lifetime physical activity and network attack tolerance contribute to the preservation of motor function in Parkinson's disease

We tested whether network resilience, quantified by network attack tolerance (NAT), is associated with dopamine terminal (DaT) integrity, motor function and lifetime factors in Parkinsons disease (PD). Data from 22 PD patients and 39 healthy controls included information on lifetime physical activity (PA), cognitive/motor performance, putaminal DaT integrity, and resting-state fMRI. NAT was assessed at global and subnetwork level by calculating global efficiency upon iterative node removal. Generalized linear-mixed-effects models were used to test the effects of PA, education, and dopamine integrity on NAT. Next, the moderating effect of lifetime factors on the association between NAT and motor function were assessed, controlling for DaT integrity. Greater putaminal DaT integrity was linked to higher somatomotor NAT. Higher global and somatomotor NAT supported motor function, especially in patients with moderate lifetime PA. Lifestyle factors may thus serve network-specific attack tolerance, thereby promoting motor preservation in PD, independent of dopaminergic impairment.