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.

The association between freezing of gait, fear of falling and anxiety in Parkinson’s disease: a longitudinal analysis

2020 ◽  
Author(s):  
Ires Ghielen ◽  
Perrie Koene ◽  
Jos WR Twisk ◽  
Gert Kwakkel ◽  
Odile A van den Heuvel ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Multidisciplinary Approach ◽  
Fear Of Falling ◽  
Freezing Of Gait ◽  
Confounding Factors ◽  
Nonmotor Symptoms ◽  
Independent Variables ◽  
Complex Interactions ◽  
Disease Characteristics

Aim: We studied the longitudinal associations between freezing of gait (FoG), fear of falling (FoF) and anxiety, and how these associations are influenced by confounding factors. Materials & methods: We analyzed longitudinal motor and nonmotor measurements from 153 Parkinson’s disease patients. Possible confounding factors were divided into three subgroups: demographics, disease characteristics, medication use and adverse effects of medication. Results: All crude associations between FoG, FoF and anxiety were significant and remained so after adjusting for confounders. When analyzing FoF and anxiety together as independent variables, the association between FoG and FoF remained, and the association between FoG and anxiety diminished. Conclusion: We confirm the complex interactions between motor and nonmotor symptoms in Parkinson’s disease, and plead for a multidisciplinary approach.

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 Investigation of Nonmotor Symptoms in First-Degree Relatives of Patients with Different Clinical Types of Parkinson’s Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Jiang-bing Liu ◽  
Jun-ling Leng ◽  
Ying-ge Wang ◽  
Yu Zhang ◽  
Tie-yu Tang ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Late Onset ◽  
Severe Depression ◽  
Nonmotor Symptoms ◽  
Sleep Behavior ◽  
First Degree Relatives

Background. Nonmotor symptoms (NMS) are prodromal characteristics of Parkinson’s disease (PD). The first-degree relatives (FDR) of PD patients had a higher risk of PD and also had more NMS. Objective. To delineate NMS in FDR of patients with different clinical types of PD. Methods. A total of 98 PD probands were recruited; 256 siblings of them were enrolled in the FDR group. Various scales were used to assess NMS, including depression, anxiety, cognitive impairment, insomnia, constipation, excessive daytime sleepiness, rapid eye movement sleep behavior disorder (RBD), and restless legs syndrome (RLS). The incidences of NMS were further compared between the FDR groups of PD with different types. Results. The FDR of early-onset PD (EOP) showed a higher incidence of moderate to severe depression (OR = 4.08; 95% CI: 1.12–14.92; P=0.033), anxiety (OR = 4.22; 95% CI: 1.87–9.52; P=0.001), and excessive daytime sleepiness (OR = 3.40; 95% CI: 1.00–11.48; P=0.049) than the FDR of late-onset PD (LOP). It was also found that RBD (OR = 11.65; 95% CI: 3.82–35.54; P<0.001), constipation (OR = 4.94; 95% CI: 1.85–13.21; P=0.001), sleep disorders (OR = 4.51; 95% CI: 1.73–11.78; P=0.002), cognitive impairment (OR = 3.55; 95% CI: 1.62–7.77; P=0.002), and anxiety (OR = 2.49; 95% CI: 1.32–4.71; P=0.005) were more frequent in FDR of tremor-dominant PD (TDP) than in FDR of non-tremor-dominant PD (NTDP). Conclusions. The siblings of patients with EOP and TDP have more NMS, presuming that they have a higher risk in the PD prodromal stage. Whether they have a greater possibility to progress into PD requires further investigation.

scholarly journals Freezing More than Gait: A Case Report of Freezing of Urination (FOU) in Parkinson’s Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Mengyuan Xu ◽  
Tao Chen ◽  
Caifei Yang ◽  
Xu Meng ◽  
Qingyun Peng ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Case Report ◽  
Freezing Of Gait ◽  
Clinical Treatment ◽  
Nonmotor Symptoms ◽  
Urinary Dysfunctions ◽  
Shed Light

Freezing of gait (FOG) is a disabling phenomenon that is described by patients with Parkinson’s disease (PD). Not only gait may be involved in the freezing phenomenon, but also some nonmotor symptoms, such as freezing of urination (FOU) in this case. The characters of urinary dysfunctions in this case resemble “off” freezing: (1) abrupt difficulty in starting or continuing in urination; (2) the urinary dysfunctions fluctuated with medication state; and (3) the urinary dysfunctions could be alleviated dramatically by an external cueing. Urinary dysfunctions in this patient (and maybe more PD patients) are associated not only with the classical “nonmotor symptoms” but also the freezing phenomenon. FOU could be a part of the spectrum of freezing symptoms. The subtypes of the freezing phenomenon will shed light on the PD pathophysiology and clinical treatment.

Deep Brain Stimulation for Freezing of Gait in Parkinson's Disease With Early Motor Complications

2019 ◽  
Vol 35 (1) ◽  
pp. 82-90 ◽  
Author(s):  
Michael T. Barbe ◽  
Lisa Tonder ◽  
Paul Krack ◽  
Bettina Debû ◽  
Michael Schüpbach ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Freezing Of Gait ◽  
Motor Complications ◽  
Deep Brain
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