Predictors of freezing of gait in Chinese patients with Parkinson's disease

Ou, Ruwei; Wei, Qianqian; Cao, Bei; Song, Wei; Hou, Yanbing; Liu, Hui; Yuan, Xianglei; Zhao, Bi; Wu, Ying; Shang, Huifang

doi:10.1002/brb3.931

Cited by 32 publications

(43 citation statements)

References 35 publications

(59 reference statements)

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“…We found FOG in PD to be unrelated to sex and only weakly associated with patient age, consistent with the majority of other prospective studies [ 4 , 8 , 10 – 12 , 30 ]. On the other hand, supporting extensive literature, we found disease duration to be strongly associated with FOG [ 4 – 7 , 9 , 12 , 13 , 31 ].…”

Section: Discussionsupporting

confidence: 92%

Freezing of Gait in Parkinson’s Disease: Risk Factors, Their Interactions, and Associated Nonmotor Symptoms

Lichter

Benedict

Hershey

2021

Parkinson's Disease

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Background. Freezing of gait (FOG) is a debilitating and incompletely understood symptom in Parkinson’s disease (PD). Objective. To determine the principal clinical factors predisposing to FOG in PD, their interactions, and associated nonmotor symptoms. Methods. 164 PD subjects were assessed in a cross-sectional retrospective study, using the MDS-UPDRS scale, MMSE, and Clinical Dementia Rating Scale. Clinical factors associated with FOG were determined using univariate analysis and nominal logistic regression. Receiver operating characteristic curves were computed, to obtain measures of sensitivity and specificity of predictors of FOG. Subgroups of patients with FOG were compared with those without FOG, based on defining aspects of their clinical phenotype. Results. Relative to non-FOG patients, those with FOG had a longer disease duration, higher PIGD and balance-gait score, higher LED, and more motor complications ( p < 0.0001 ) and were more likely to exhibit urinary dysfunction ( p < 0.0003 ), cognitive impairment, hallucinations, and psychosis ( p = 0.003 ). The balance-gait score and motor complications, at their optimum cutoff values, together predicted FOG with 86% accuracy. Interactions were noted between cognitive dysfunction and both the Bal-Gait score and motor complication status, cognitive impairment or dementia increasing the likelihood of FOG in subjects without motor complications ( p = 0.0009 ), but not in those with motor complications. Conclusions. Both disease and treatment-related factors, notably LED, influence the risk of FOG in PD, with a selective influence of cognitive dysfunction in patients with balance-gait disorder but not in those with motor fluctuations. These findings may help to inform clinical management and highlight distinct subgroups of patients with PD-FOG, which are likely to differ in their network pathophysiology.

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Section: Discussionsupporting

confidence: 92%

Freezing of Gait in Parkinson’s Disease: Risk Factors, Their Interactions, and Associated Nonmotor Symptoms

Lichter

Benedict

Hershey

2021

Parkinson's Disease

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“…This result suggested that patients with FOG needed more dopaminergic drugs in order to improve motor symptoms and reach a nearly normal life compared with those without FOG. This phenomenon was also observed in other studies in which patients with FOG needed more dopaminergic drugs and were mainly in the advanced stage of PD 21,22. Our data did not find that FOG was associated with the motor severity according to the scores of Hoehn–Yahr stage and UPDRS-Ⅲ.…”

Section: Discussionsupporting

confidence: 83%

“…FOG is a common disabling symptom mainly at the advanced stage of disease and the prevalence has varied from 7% in PD patients with a recent diagnosis to 63% 19,20,21. FOG prevalence reflects a mixed population of patients with early and advanced disease, most of whom could be improved by dopaminergic drugs.…”

Section: Discussionmentioning

confidence: 99%

<p>Dopaminergic pathway and primary visual cortex are involved in the freezing of gait in Parkinson’s disease: a PET-CT study</p>

Zhou

Zhao

Hou

et al. 2019

NDT

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Background: Freezing of gait (FOG) could be partly alleviated by dopaminergic drugs but the mechanism still needs to be elucidated. The purpose of this study is to explore the mechanisms of FOG by vesicular monoamine transporter VMAT2 distribution with the 18 F-AV133 tracer and 18-fludeoxyglucose positron emission tomography–computed tomography ( 18 F-FDG PET-CT). Methods: Clinical material and PET-CT data were collected from 20 patients with FOG and 147 patients without FOG from November 1, 2017 to October 31, 2018. Brain scans of all participants were acquired over an approximately 20-min period, 120 min after injection of approximately 250 MBq 18 F-AV133. The mean uptake ratios of different regions were identified by NeuroQ software of 18 F-FDG PET-CT. Data analysis included variance, chi-square analysis, covariance analysis, and logistic regression. Results: Our data showed that patients with FOG were provided with greater doses of dopaminergic drugs ( p <0.05). The frequency of FOG was 11.98% and increased as Parkinson’s disease progressed. FOG was more common in the elderly and strongly associated with the duration. Cognitive impairments were obvious, assessed by Mini-Mental State Examination and Montreal Cognitive Assessment ( p <0.05). The VMAT2 distribution with 18 F-AV133 was decreased significantly in the caudate nucleus and lentiform nucleus while the metabolism of these areas was elevated, determined by 18 F-FDG PET-CT ( p <0.05). The metabolism of the primary visual cortex decreased obviously in patients with FOG compared with those without FOG ( p <0.05). Conclusion: FOG mainly occurred in the advanced stage, and was strongly associated with the duration and larger dose of dopaminergic drugs. The dopamine level of the nigrostriatal system decreased significantly and the uptake ratios of the primary visual cortex dropped obviously in the FOG group compared with the non-FOG group. Our study suggests that both the dopaminergic pathway and the primary visual cortex are involved in the pathogenesis of FOG.

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“…Incidence increases with disease duration but clinically it is difficult to predict which patients will transition to develop FOG. A number of factors contribute to FOG risk which include age, anxiety, depression, and severity of motor symptoms but the role of cognition in the development of FOG is still debated in the literature [5][6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

Cognitive function in people with and without freezing of gait in Parkinson’s disease

Morris

Smulders

Peterson

et al. 2020

npj Parkinsons Dis.

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Freezing of gait (FOG) is common in people with Parkinson's disease (PD) which is extremely debilitating. One hypothesis for the cause of FOG episodes is impaired cognitive control, however, this is still in debate in the literature. We aimed to assess a comprehensive range of cognitive tests in older adults and people with Parkinson's with and without FOG and associate FOG severity with cognitive performance. A total of 227 participants took part in the study which included 80 healthy older adults, 81 people with PD who did not have FOG and 66 people with PD and FOG. A comprehensive battery of neuropsychological assessments tested cognitive domains of global cognition, executive function/attention, working memory, and visuospatial function. The severity of FOG was assessed using the new FOG questionnaire and an objective FOG severity score. Cognitive performance was compared between groups using an ANCOVA adjusting for age, gender, years of education and disease severity. Correlations between cognitive performance and FOG severity were analyzed using partial correlations. Cognitive differences were observed between older adults and PD for domains of global cognition, executive function/attention, and working memory. Between those with and without FOG, there were differences for global cognition and executive function/attention, but these differences disappeared when adjusting for covariates. There were no associations between FOG severity and cognitive performance. This study identified no significant difference in cognition between those with and without FOG when adjusting for covariates, particularly disease severity. This may demonstrate that complex rehabilitation programs may be undertaken in those with FOG.

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Predictors of freezing of gait in Chinese patients with Parkinson's disease

Cited by 32 publications

References 35 publications

Freezing of Gait in Parkinson’s Disease: Risk Factors, Their Interactions, and Associated Nonmotor Symptoms

Freezing of Gait in Parkinson’s Disease: Risk Factors, Their Interactions, and Associated Nonmotor Symptoms

<p>Dopaminergic pathway and primary visual cortex are involved in the freezing of gait in Parkinson’s disease: a PET-CT study</p>

Cognitive function in people with and without freezing of gait in Parkinson’s disease

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