Discriminative compensatory activation during auditory beat perception in Parkinson’s disease and multiple system atrophy

Introduction: Auditory beat perception (ABP) is crucial for rhythmic auditory stimulation (RAS), a therapeutic approach for neurological disorders, and particularly Parkinson’s disease (PD). The mechanism is thought to be associated with increased activation of the cerebellum and motor-related regions. However, few studies have explored its effects on patients with multiple system atrophy (MSA). This study aimed to compare the compensatory mechanism of ABP in patients with PD and MSA. Methods: Participants with PD and MSA and normal controls (NCs) were recruited from National Cheng Kung University Hospital. During task-based functional MRI (fMRI), the participants listened to rhythmic beat sounds using a boxcar paradigm. Basic characteristics and brain volumes were compared between the PD and MSA groups, and fMRI findings were further compared with the NCs. Results: There were no significant differences in age, gender, motor scores or disease duration between PD (n = 16) and MSA (n = 14) groups. Brain volume analysis revealed a significant reduction in cerebellar volume in the MSA group. ABP analysis via fMRI demonstrated greater activation in the left premotor cortex in MSA groups compared to NCs. Activation in the right cerebellum was significantly higher in PD group but absent in the MSA group. Different correlation trends between activation and cerebellar volume were observed. Conclusion: ABP in the PD and MSA groups showed distinct compensatory mechanisms by cerebellar and premotor cortex activation, respectively. These findings provide insights into compensatory mechanisms regarding RAS therapy in patients with atypical parkinsonian disorders.