scholarly journals Falls risk is predictive of dysphagia in Parkinson’s disease

2021 ◽  
Author(s):  
Christopher Kobylecki ◽  
Irena Shiderova ◽  
Mihaela Boca ◽  
Emilia Michou
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Correlation Analysis ◽  
Freezing Of Gait ◽  
Gait Disturbance ◽  
Common Symptom ◽  
Factors Associated ◽  
Axial Symptoms ◽  
Gait Score ◽  
The Relationship

Abstract Objective Evaluate the relationship between falls, freezing of gait, and swallowing disturbance in Parkinson’s disease (PD). Background Dysphagia is a common symptom in PD, and is often thought of as an axial feature along with falls and gait disturbance. It is of interest to examine the relationship between these symptoms in PD, given the possibility of shared pathophysiology due to non-dopaminergic and extranigral dysfunction. Methods We recruited 29 consecutive non-demented patients with idiopathic PD and at least one clinically determined impairment in swallowing, falls, or freezing of gait. Swallow dysfunction was assessed using the Swallowing Disturbance Questionnaire (SDQ). The Falls Efficacy Scale and Freezing-of-gait questionnaire were recorded. Correlation analysis and multiple regression were used to determine the relationship between swallow and gait disturbance. Results Total SDQ score correlated strongly with the falls efficacy scale (Spearman’s rho = 0.594; P = 0.001), but not with the freezing-of-gait score. Linear regression controlling for other factors associated with dysphagia identified falls efficacy score as a significant predictor of swallow dysfunction. Conclusions The severity of dysphagia in PD is closely related to severity of falls, but not gait freezing. This may be helpful to more precisely determine the anatomical substrate of levodopa-resistant axial symptoms in PD and provide clues to further management.

scholarly journals The Relationship between Pain, and Freezing of Gait and Falls in Parkinson’s Disease

2019 ◽  
Author(s):  
Nesrin Helvaci Yilmaz ◽  
Mevhibe Saricaoglu ◽  
Hale Yapici Eser ◽  
Ozge Arici Duz ◽  
Burcu Polat ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Freezing Of Gait ◽  
The Relationship

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

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
David Gordon Lichter ◽  
Ralph Holmes Boring Benedict ◽  
Linda Ann Hershey
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Cognitive Dysfunction ◽  
Univariate Analysis ◽  
Freezing Of Gait ◽  
Motor Complications ◽  
Clinical Factors ◽  
Nonmotor Symptoms ◽  
Gait Score

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.

Factors associated with freezing of gait in patients with Parkinson’s disease

2018 ◽  
Vol 40 (2) ◽  
pp. 293-298 ◽  
Author(s):  
Seong-Min Choi ◽  
Hyun-Jung Jung ◽  
Geum-Jin Yoon ◽  
Byeong C. Kim
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Freezing Of Gait ◽  
Factors Associated

scholarly journals Relationships between freezing of gait severity and cognitive deficits in Parkinson's disease

2021 ◽  
Author(s):  
Jamie L. Scholl ◽  
Arturo I. Espinoza ◽  
Matt Leedom ◽  
Lee A. Baugh ◽  
Patti Berg-Poppe ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Cognitive Functioning ◽  
Freezing Of Gait ◽  
Interval Timing ◽  
Cognitive Domains ◽  
Timing Task ◽  
The Relationship ◽  
Mediation Models

Introduction: Freezing of gait (FOG) is one of the most debilitating motor symptoms experienced by patients with Parkinson's disease (PD), as it can lead to falls and reduced quality of life. Evidence supports an association between FOG severity and cognitive functioning; however, results are varied. Methods: PD patients with (PDFOG+, n=41) and without FOG (PDFOG-, n=39) and control healthy subjects (n=41) participated in the study. The NIH toolbox cognition battery, Montreal cognitive assessment (MoCA), and interval timing task were used to test cognitive domains. Measurements were compared between groups using multivariable models and adjusting for covariates. Correlation analyses, linear regression, and mediation models were applied to examine relationships among disease duration and severity, FOG severity, and cognitive functioning. Results: Significant differences were observed between controls and PD patients for all cognitive domains. PDFOG+ and PDFOG- exhibited differences in the dimensional change card sort (DCCS) test, interval timing task, and MoCA scores. After adjusting for covariates in two different models, PDFOG+ and PDFOG- differed in both MoCA and DCCS scores. In addition, significant relationships between FOG severity and cognitive function (MoCA, DCCS, and interval timing) were also found. Regression models suggest that FOG severity may be a predictor of cognitive impairment, and mediation models show the effects of cognitive impairment on the relationship between disease severity and FOG severity. Conclusions: Overall, this study provides insight into the relationship between cognitive and gait impairments in patients with PD, which could aid in the development of therapeutic interventions to manage both.

scholarly journals Recurrent Falls in Parkinson’s Disease: A Systematic Review

2013 ◽  
Vol 2013 ◽  
pp. 1-16 ◽  
Author(s):  
Natalie E. Allen ◽  
Allison K. Schwarzel ◽  
Colleen G. Canning
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Fear Of Falling ◽  
Freezing Of Gait ◽  
Motor Impairment ◽  
Journal Articles ◽  
Factors Associated ◽  
Recurrent Falls ◽  
Wide Range ◽  
Reduced Physical Activity

Most people with Parkinson’s disease (PD) fall and many experience recurrent falls. The aim of this review was to examine the scope of recurrent falls and to identify factors associated with recurrent fallers. A database search for journal articles which reported prospectively collected information concerning recurrent falls in people with PD identified 22 studies. In these studies, 60.5% (range 35 to 90%) of participants reported at least one fall, with 39% (range 18 to 65%) reporting recurrent falls. Recurrent fallers reported an average of 4.7 to 67.6 falls per person per year (overall average 20.8 falls). Factors associated with recurrent falls include: a positive fall history, increased disease severity and duration, increased motor impairment, treatment with dopamine agonists, increased levodopa dosage, cognitive impairment, fear of falling, freezing of gait, impaired mobility and reduced physical activity. The wide range in the frequency of recurrent falls experienced by people with PD suggests that it would be beneficial to classify recurrent fallers into sub-groups based on fall frequency. Given that there are several factors particularly associated with recurrent falls, fall management and prevention strategies specifically targeting recurrent fallers require urgent evaluation in order to inform clinical practice.

scholarly journals Safety and Tolerability of Burst-Cycling Deep Brain Stimulation for Freezing of Gait in Parkinson’s Disease

2021 ◽  
Vol 15 ◽  
Author(s):  
Joshua K. Wong ◽  
Wei Hu ◽  
Ryan Barmore ◽  
Janine Lopes ◽  
Kathryn Moore ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Freezing Of Gait ◽  
Functional Mobility ◽  
Common Symptom ◽  
Burst Frequency ◽  
Serious Adverse Events ◽  
Deep Brain

Background: Freezing of gait (FOG) is a common symptom in Parkinson’s disease (PD) and can be difficult to treat with dopaminergic medications or with deep brain stimulation (DBS). Novel stimulation paradigms have been proposed to address suboptimal responses to conventional DBS programming methods. Burst-cycling deep brain stimulation (BCDBS) delivers current in various frequencies of bursts (e.g., 4, 10, or 15 Hz), while maintaining an intra-burst frequency identical to conventional DBS.Objective: To evaluate the safety and tolerability of BCDBS in PD patients with FOG.Methods: Ten PD subjects with STN or GPi DBS and complaints of FOG were recruited for this single center, single blinded within-subject crossover study. For each subject, we compared 4, 10, and 15 Hz BCDBS to conventional DBS during the PD medication-OFF state.Results: There were no serious adverse events with BCDBS. It was feasible and straightforward to program BCDBS in the clinic setting. The benefit was comparable to conventional DBS in measures of FOG, functional mobility and in PD motor symptoms. BCDBS had lower battery consumption when compared to conventional DBS.Conclusions: BCDBS was feasible, safe and well tolerated and it has potential to be a viable future DBS programming strategy.

scholarly journals Amyloid ß Impacts Future Freezing of Gait in Parkinson’s Disease Via White Matter Hyperintensities

2020 ◽  
Author(s):  
Mahsa Dadar ◽  
Janis Miyasaki ◽  
Simon Duchesne ◽  
Richard Camicioli
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
White Matter ◽  
White Matter Hyperintensities ◽  
Freezing Of Gait ◽  
Amyloid Β ◽  
Common Symptom ◽  
Activity Levels ◽  
Lewy Body Pathology ◽  
The Impact

AbstractBackgroundFreezing of gait (FOG) is a common symptom in Parkinson’s Disease (PD) patients. Previous studies have reported relationships between FOG, substantia nigra (SN) degeneration, dopamine transporter (DAT) concentration, as well as amyloid β deposition. However, there is a paucity of research on the concurrent impact of white matter damage.ObjectivesTo assess the inter-relationships between these different co-morbidities, their impact on future FOG and whether they act independently of each other.MethodsWe used baseline MRI and longitudinal gait data from the Parkinson’s Progression Markers Initiative (PPMI). We used deformation based morphometry (DBM) from T1-weighted MRI to measure SN atrophy, and segmentation of white matter hyperintensities (WMH) as a measure of WM pathological load. Putamen and caudate DAT levels from SPECT as well as cerebrospinal fluid (CSF) amyloid β were obtained directly from the PPMI. Following correlation analyses, we investigated whether WMH burden mediates the impact of amyloid β on future FOG.ResultsSN DBM, WMH load, putamen and caudate DAT activity and CSF amyloid β levels were significantly different between PD patients with and without future FOG (p < 0.008). Mediation analysis demonstrated an effect of CSF amyloid β levels on future FOG via WMH load, independent of SN atrophy and striatal DAT activity levels.ConclusionsAmyloid β might impact future FOG in PD patients through an increase in WMH burden, in a pathway independent of Lewy body pathology.

scholarly journals Freezing of gait and postural instability: the unpredictable response to levodopa in Parkinson’s disease

2019 ◽  
Vol 12 (7) ◽  
pp. e229224 ◽  
Author(s):  
Fradique Moreira ◽  
Inês Rebelo Gomes ◽  
Cristina Januário
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Freezing Of Gait ◽  
Postural Instability ◽  
Motor Symptoms ◽  
Levodopa Dose ◽  
Paradoxical Response ◽  
Axial Symptoms ◽  
Video Documentation ◽  
Dose Dependent

Freezing of gait (FOG) and postural instability are challenging motor symptoms that present a serious therapeutic dilemma in Parkinson’s disease. Appropriate distinction between FOG subtypes may be difficult during routine clinical visits, as shown in the case we present. The patient was examined in three different states in relation to levodopa (L-DOPA) and apomorphine subcutaneous (sc) tests with video documentation: (1) ‘overnight-off’, after 12 hours without medication; (2)‘on’, 60 min after intake of regular levodopa dose (200 mg) and 20 min after 2 mg of apomorphine sc; and (3) ‘supra-on’, after 350 mg of L-DOPA and 3 mg of apomorphine sc. The patient clearly showed a dose-dependent paradoxical response to L-DOPA treatment with the emergence of severe FOG and postural instability. The tendency to develop these axial symptoms was less pronounced with apomorphine at doses that achieved similar improvements of other Parkinsonian features.

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