A two‐year follow‐up study of executive dysfunctions in Parkinsonian patients with freezing of gait at on‐state

Amboni, Marianna; Barone, Paolo; Picillo, Marina; Cozzolino, Autilia; Longo, Katia; Erro, Roberto; Iavarone, Alessandro

doi:10.1002/mds.23033

Cited by 75 publications

(63 citation statements)

References 5 publications

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“…This pattern has been confirmed in another recent study. 29 Consistent with previous neuropsychological evidence, 6,30 patients with FOGϩ performed worse than those with FOGϪ on several cognitive tests. In particular, patients with FOGϩ displayed predominant executive-visuospatial impairment as evidenced by reduced scores on the Frontal Assessment Battery, phonemic verbal fluency, and Ten-Point Clock Test.…”

Section: Discussionsupporting

confidence: 84%

“…As reported, previous studies have shown an association between frontal dysfunction and FOG in patients with PD. 6,7,30 Recent studies 43,44 have demonstrated, by evaluating the influence of space perception on gait in patients with PD, that visuospatial ability appears to be more greatly affected in patients with PD who experience FOG. Furthermore, external visual, mental, and auditory cues (ie, extrinsic drivers) can usually improve FOG.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Regional Gray Matter Atrophy in Patients with Parkinson Disease and Freezing of Gait

Tessitore

Amboni

Cirillo

et al. 2012

AJNR Am J Neuroradiol

105

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Regional Gray Matter Atrophy in Patients with Parkinson Disease and Freezing of Gait

Tessitore

Amboni

Cirillo

et al. 2012

AJNR Am J Neuroradiol

105

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“…Several common characteristics emerged: 1) a trembling FOG type which worsened with increasing levodopa doses; 2) debut of "on" FOG without predating "off " FOG, after a short disease duration and brief dopaminergic treatment; 3) concurrent worsening (freezing) of repetitive alternating hand movements in the "on" state; 4) good levodopa responsiveness of other parkinsonian features; and 5) preserved cognition, unlike the frontal cognitive impairment associated with "off " FOG. 5 In 3 patients FOG affected open space walking as much as turning and gait initiation, unlike classic "off " FOG, where turning is much more affected compared to straight walking. 1 These features point to a different pathophysiology underlying "on" and "off " FOG, and suggest that "on" FOG does not result from an effect of dopaminergic drugs on alertness, from orthostatic hypotension, or from isolated D2 agonism in the absence of D1 stimulation.…”

mentioning

confidence: 95%

“On” state freezing of gait in Parkinson disease

Espay

Fasano²,

Nuenen³

et al. 2012

Neurology

187

134

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Objective: To describe the phenotype of levodopa-induced "on" freezing of gait (FOG) in Parkinson disease (PD). Methods:We present a diagnostic approach to separate "on" FOG (deterioration during the "on state") from other FOG forms. Four patients with PD with suspected "on" FOG were examined in the "off state" (Ͼ12 hours after last medication intake), "on state" (peak effect of usual medication), and "supra-on" state (after intake of at least twice the usual dose).Results: Patients showed clear "on" FOG, which worsened in a dose-dependent fashion from the "on" to the "supra-on" state. Two patients also demonstrated FOG during the "off state," of lesser magnitude than during "on." In addition, levodopa produced motor blocks in hand and feet movements, while other parkinsonian features improved. None of the patients had cognitive impairment or a predating "off " FOG. Conclusions:True "on" FOG exists as a rare phenotype in PD, unassociated with cognitive impairment or a predating "off " FOG. Distinguishing the different FOG subtypes requires a comprehensive motor assessment in at least 3 medication states. Neurology Freezing of gait (FOG) is common in Parkinson disease (PD). FOG refers to sudden, relatively brief episodes of gait arrest, experienced subjectively by patients as their feet being "glued to the floor."1 The relationship between FOG and dopaminergic medication is complex. Most common is "off " FOG, which is relieved by dopaminergic medication.1 Less well recognized types include "unresponsive FOG," which is indifferent to changes in dopaminergic medication 2,3 ; "pseudo-on" FOG, seen during a seemingly optimal "on" state, but which nevertheless improves with stronger dopaminergic stimulation; and "on" FOG, induced by dopaminergic medication. 4 Here, we describe the phenotype of "on" FOG, illustrated by 4 patients with PD. We also present a diagnostic approach to separate the various FOG subtypes, as a basis for understanding pathophysiology and for tailored therapeutic intervention.METHODS Four patients (ages 59 -82, disease duration 6 -20 years) with a history of deteriorating FOG during "on" are described in appendix e-1 on the Neurology ® Web site at www.neurology.org. Subjects were tested in 3 states: 1) "practically defined off " state, after 12 hours without medication; 2) "on" state, 45-60 minutes after intake of regular levodopa doses; and 3) "supra-on" state, after at least twice the regular dose. The Institutional Review Board approved the study protocol and written informed consent was obtained. These tests were done on 1 day, in a fixed order, without blinding. Subject 3 was also tested 1 month later in the "supra-off " state, after 72 hours without any medication. Motor evaluations included the Unified Parkinson's Disease Rating Scale (UPDRS)-III subscale (table e-1) and timed gait tasks (gait initiation, straight walking with 2 180-degree turns, and 1 360-degree turn in each direction). Determination of FOG appearance was based on patient and investigator judgment.Standard proto...

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“…92 Motor symptoms, as freezing of gait, may represent as a biomarker of development of cognitive impairment and dementia. 93,94 Indeed, gait is not merely considered a pure motor task as evidence shows the influence of specific cognitive profiles on gait parameters suggesting the existence of a complex interplay between gait and cognition. 95,96 NMS generally tend to remain stable during the early phase of disease, with only a few of them being affected by dopaminergic therapy and, specifically, by the use of dopamine agonists (ie, reduction in depression and increase in weight).…”

Section: Biomarkers Of Progression Clinical Biomarkersmentioning

confidence: 99%

Biomarkers of Parkinson's disease: recent insights, current challenges, and future prospects

Picillo¹,

Moccia²,

Spina³

et al. 2016

JPRLS

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A two‐year follow‐up study of executive dysfunctions in Parkinsonian patients with freezing of gait at on‐state

Cited by 75 publications

References 5 publications

Regional Gray Matter Atrophy in Patients with Parkinson Disease and Freezing of Gait

Regional Gray Matter Atrophy in Patients with Parkinson Disease and Freezing of Gait

“On” state freezing of gait in Parkinson disease

Biomarkers of Parkinson's disease: recent insights, current challenges, and future prospects

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A two‐year follow‐up study of executive dysfunctions in Parkinsonian patients with freezing of gait at on‐state

Cited by 75 publications

References 5 publications

Regional Gray Matter Atrophy in Patients with Parkinson Disease and Freezing of Gait

Regional Gray Matter Atrophy in Patients with Parkinson Disease and Freezing of Gait

“On” state freezing of gait in Parkinson disease

Biomarkers of Parkinson&#39;s disease: recent insights, current challenges, and future prospects

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Biomarkers of Parkinson's disease: recent insights, current challenges, and future prospects