Prevalence, Determinants, and Effect on Quality of Life of Freezing of Gait in Parkinson Disease

Abstract

IMPORTANCE Freezing of gait (FOG) is a common axial symptom of Parkinson disease (PD). OBJECTIVE To determine the prevalence of FOG in a large group of PD patients, assess its relationship with quality of life and clinical and pharmacological factors, and explore its changes from the off to on conditions in patients with motor fluctuations. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional survey of 683 patients with idiopathic PD. Scores for FOG were missing in 11 patients who were not included in the analysis. Patients were recruited from referral centers and general neurology clinics in public or private institutions in France. EXPOSURE Patients with FOG were identified as those with a score of 1 or greater on item 14 of the Unified Parkinson's Disease Rating Scale (UPDRS) in the on condition. Item 14 scores for FOG in the off condition were also collected in patients with fluctuating motor symptoms. MAIN OUTCOMES AND MEASURES Quality of life (measured by the 39-item Parkinson's Disease Questionnaire and 36-Item Short Form Health Survey), anxiety and depression (Hospital Anxiety and Depression Scale), clinical features (UPDRS), and drug consumption. RESULTS Of 672 PD patients, 257 reported FOG during the on state (38.2%), which was significantly related to lower quality of life scores (P < .01). Freezing of gait was also correlated with longer PD duration (odds ratio, 1.92 [95% CI, 1.28-2.86]), higher UPDRS parts II and III scores (4.67 [3.21-6.78]), the presence of apathy (UPDRS item 4) (1.94 [1.33-2.82]), a higher levodopa equivalent daily dose (1.63 [1.09-2.43]), and more frequent exposure to antimuscarinics (3.07 [1.35-6.97]) (logistic regression). The FOG score improved from the off to on states in 148 of 174 patients with motor fluctuations (85.1%) and showed no change in 13.8%. The FOG score improved by more than 50% in 43.7% of patients. Greater improvement in the on state was observed in younger patients (r = −0.25; P < .01) with lower UPDRS II and III scores (r = −0.50; P < .01) and no antimuscarinic use (r = −0.21; P < .01). CONCLUSIONS AND RELEVANCE Freezing of gait in PD patients correlates with poor quality of life, disease severity, apathy, and exposure to antimuscarinics. Dopaminergic therapy improved FOG in most patients with motor fluctuations, especially younger ones with less severe disease and no antimuscarinic use. This finding suggests that quality of life is impaired in PD patients with FOG and that optimizing dopaminergic therapy and avoiding antimuscarinics should be considered.

A 12-year population-based study of freezing of gait in Parkinson's disease

“…This estimate is higher than those observed for psychosis and dementia reported previously in our cohort [16,17]. FOG has been associated with reduced quality of life [7] and increased risk for falls [9] and loss of independence [9]. Together, these observations highlight FOG as a major motor disability in patients with PD.…”

“…FOG in PD is associated with increased risk for falls [9], loss of independence [9], and impaired quality of life [7]. Hence, early identification of those who are at risk of developing FOG would be valuable for patients, caregivers, and health care planning.…”

Quality of Life and Caregivers' Burden of Parkinson's Disease

“…PD patients perceive that they need help from others at some time even to manage their daily living activities; this contributes to their loss of independence [18]. Gait abnormalities and dyskinesia in PD patients may occur due to dopamine drug on-off fluctuations and this has a direct effect on their QoL [19,20]. …”

Monitoring Parkinson Disease from speech articulation kinematics

“…Usually, disease progress is clinically evaluated by means of general scales as Hoehn & Yahr (1967) or UPDRS (Goetz et al, 2007). Besides, neurologists also use other tests that evaluate freezing of gait (FOG), non-motor symptoms (NMSS), REM sleep behavior disorder (RBDSQ), faciokinesis (FK), phono-respiratory competence (PRC), or phonetic competence (PC; see Fénelon, et al, 2000;Pérez-Lloret, et al, 2014;Stiasny-Kolster, et al, 2015;Ziemssen & Reichmann, 2007). Therefore, Pearson's correlation between D KL and each of the available scores in the set S = {Age, UPDRSIII, UPDRSIV, FOG, NMSS, RBDSQ, LED, FK, PRC, PC, OC, PRN} is evaluated, where OC is the average of FK, PRC and PC, whereas PRN is the z-scored correlate of PRC.…”