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Sakai K, Kawasaki T, Kiminarita H, Kim K, Ogawa J. Validity, reliability, and measurement error of the Japanese version of the Freezing of Gait Questionnaire for patients with Parkinson's disease. Physiother Theory Pract 2024:1-7. [PMID: 38813872 DOI: 10.1080/09593985.2024.2361325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/24/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The Freezing of Gait Questionnaire has been translated into several languages. However, it has not been translated into Japanese and its measurement error remains unclear.Objectives: This study aimed to translate the Freezing of Gait Questionnaire into Japanese, investigate its validity and reliability, and calculate its measurement errors. METHODS Thirty-five patients with Parkinson's disease participated in the study. The Freezing of Gait Questionnaire was translated into Japanese using a forward - backward translation method. Convergent validity was assessed using the Freezing of Gait Questionnaire and Unified Parkinson's Disease Rating Scale Part II(item 14-freezing). The content validity index was calculated using the Freezing of Gait Questionnaire score using correlation coefficients. Internal consistency was measured using Cronbach's alpha. The test - retest reliability was evaluated using the intraclass correlation coefficient(1,1). The Bland - Altman analysis was performed to detect the limits of agreement. RESULTS The mean Freezing of Gait Questionnaire score was 9.1 (5.0) points. Convergent validity was 0.655 and content validity index was 0.958. Cronbach's alpha was 0.958, intraclass correlation coefficient(1,1) was 0.951, and the limits of agreement ranged from - 4.9 to3.2 points. CONCLUSIONS The Japanese version of the Freezing of Gait Questionnaire is a valid and useful tool to evaluate patients with Parkinson's disease.
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Affiliation(s)
- Katsuya Sakai
- Department of Physical Therapy, Faculty of Healthcare Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Tsubasa Kawasaki
- Department of Physical Therapy, School of Health Sciences, Tokyo International University, Kawagoe, Japan
| | - Hiroya Kiminarita
- Department of Rehabilitation, Kirameki Visiting Nursing Rehabilitation, Kawagoe, Japan
| | - Kichol Kim
- Department of Rehabilitation, Kawaguchi Neurosurgery Rehabilitation Clinic, Osaka, Japan
| | - Jyunya Ogawa
- Department of Rehabilitation, PDit Studio, Tokyo, Japan
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Milane T, Hansen C, Correno MB, Chardon M, Barbieri FA, Bianchini E, Vuillerme N. Comparison of sleep characteristics between Parkinson's disease with and without freezing of gait: A systematic review. Sleep Med 2024; 114:24-41. [PMID: 38150950 DOI: 10.1016/j.sleep.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/03/2023] [Accepted: 11/15/2023] [Indexed: 12/29/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by a range of motor and non-motor symptoms. Among the motor complaints, freezing of gait (FOG) is a common and disabling phenomenon that episodically hinders patients' ability to produce efficient steps. Concurrently, sleep disorders are prevalent in PD and significantly impact the quality of life of affected individuals. Numerous studies have suggested a bidirectional relationship between FOG and sleep disorders. Therefore, our objective was to systematically review the literature and compare sleep outcomes in PD patients with FOG (PD + FOG) and those without FOG (PD-FOG). By conducting a comprehensive search of the PubMed and Web of Science databases, we identified 20 eligible studies for inclusion in our analysis. Our review revealed that compared to PD-FOG, PD + FOG patients exhibited more severe symptoms of rapid eye movement sleep behavior disorder in nine studies, increased daytime sleepiness in eight studies, decreased sleep quality in four studies, and more frequent and severe sleep disturbances in four studies. These findings indicate that PD + FOG patients generally experience worse sleep quality, higher levels of daytime sleepiness, and more disruptive sleep disturbances compared to those without FOG (PD-FOG). The association between sleep disturbances and FOG highlights the importance of evaluating and monitoring these symptoms in PD patients and open the possibility for future studies to assess the impact of managing sleep disturbances on the severity and occurrence of FOG, and vice versa.
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Affiliation(s)
- Tracy Milane
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; Department of Neurology, UKSH Campus Kiel, Kiel University, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Clint Hansen
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; Department of Neurology, UKSH Campus Kiel, Kiel University, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany.
| | - Mathias Baptiste Correno
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; Department of Neurology, UKSH Campus Kiel, Kiel University, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Matthias Chardon
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Fabio A Barbieri
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Edoardo Bianchini
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189, Rome, Italy
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000, Grenoble, France; Institut Universitaire de France, 75005, Paris, France.
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Korkusuz S, Seçkinoğulları B, Özcan A, Demircan EN, Çakmaklı GY, Armutlu K, Yavuz F, Elibol B. Effects of freezing of gait on balance in patients with Parkinson's disease. Neurol Res 2023; 45:407-414. [PMID: 36413435 DOI: 10.1080/01616412.2022.2149510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/16/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the effects of freezing of gait (FOG) on static and dynamic balance. METHODS Twenty patients with Parkinson's disease with and without FOG [PD+FOG (68,6±6,39 years) and PD-FOG group (70,6±4,57 years)] and 10 healthy individuals (68,4±4,92 years) with similar demographic characteristics were included in the study. Balance was compared between the three groups. Balance was evaluated with clinical tests Limits of stability (LoS) and body sway were measured using the E-LINK FP3 Force Plate and the Korebalance Balance Evaluation System, which measure the balance in static and dynamic conditions. Center of pressure (COP) change and average sway velocity were evaluated with the Zebris RehaWalk system. RESULTS Total and subscale scores of the Unified Parkinson's Disease Rating Scale were significantly higher in the PD+FOG group (p<0.05). The balance test results for both groups were similar (p>0.05). The PD+FOG group performed worse on the computerized static balance tests, the COP analysis, and the dynamic balance total score than the other two groups (p<0.05). The PD+FOG group had significantly greater sustained weight deviation than the healthy controls (p<0.05). Patients with Parkinson's disease had a lower LoS in the posterior direction than healthy controls (p<0.05). DISCUSSION FOG affects the dynamic balance more negatively than the static balance. In addition, FOG reduces LoS in the posterior direction and increases body sway in the anterior-posterior direction, which can lead to falls.
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Affiliation(s)
- Süleyman Korkusuz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Büşra Seçkinoğulları
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ayşenur Özcan
- Department of Physical Therapy and Rehabilitation, Çankırı Karatekin University, Çankırı, Turkey
| | - Emine Nur Demircan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Gül Yalçın Çakmaklı
- School of Medicine, Neurology Department, Hacettepe University, Ankara, Turkey
| | - Kadriye Armutlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ferdi Yavuz
- Faculty of Health Sciences, European University of Lefke, Lefke, Cyprus
| | - Bülent Elibol
- School of Medicine, Neurology Department, Hacettepe University, Ankara, Turkey
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Milane T, Hansen C, Chardon M, Bianchini E, Vuillerme N. Comparing Backward Walking Performance in Parkinson's Disease with and without Freezing of Gait-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:953. [PMID: 36673709 PMCID: PMC9859157 DOI: 10.3390/ijerph20020953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Parkinson's disease (PD) is a neurodegenerative disease characterized by motor symptoms and gait impairments. Among them, freezing of gait (FOG) is one of the most disabling manifestations. Backward walking (BW) is an activity of daily life that individuals with PD might find difficult and could cause falls. Recent studies have reported that gait impairments in PD were more pronounced in BW, particularly in people presenting FOG. However, to the best of our knowledge, no systematic review has synthetized the literature which compared BW performance in PD patients with and without FOG. OBJECTIVE The aim of this study was to evaluate the differences in BW performance between PD patients with FOG and PD patients without FOG. METHODS Two databases, PubMed and Web of Science, were systematically searched to identify studies comparing BW performance in PD patients with and without FOG. The National Institutes of Health (NIH) tool was used to assess the quality of the studies included. RESULTS Seven studies with 431 PD patients (179 PD with FOG and 252 PD without FOG) met the inclusion criteria and were included in this review. Among them, 5 studies reported walking speed, 3 studies step length, stride length and lower limb range of motion, 2 studies functional ambulation profile, toe clearance height, swing, and stance percent and 1 study reported the decomposition index and stepping coordination. Compared to PD patients without FOG, PD patients with FOG showed slower walking speed and reduced step length in 3 studies, shorter stride length, lower functional ambulation profile and decreased ankle range of motion in 2 studies, and smaller swing percent, higher stance percent, worse stepping coordination, greater decomposition between movements, and lower toe clearance height in one study. CONCLUSION Despite the small number of included studies, the findings of this review suggested that PD patients with FOG have worse gait performance during the BW task than PD without FOG.
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Affiliation(s)
- Tracy Milane
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France
- Department of Neurology, UKSH Campus Kiel, Kiel University, Arnold-Heller-Str. 3, Haus D, 24105 Kiel, Germany
| | - Clint Hansen
- Department of Neurology, UKSH Campus Kiel, Kiel University, Arnold-Heller-Str. 3, Haus D, 24105 Kiel, Germany
| | | | - Edoardo Bianchini
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France
- Department of Neurology, UKSH Campus Kiel, Kiel University, Arnold-Heller-Str. 3, Haus D, 24105 Kiel, Germany
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
- Institut Universitaire de France, 75005 Paris, France
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Cassidy I, Doody O, Meskell P. Exploring factors that influence HRQoL for people living with Parkinson's in one region of Ireland: A cross-sectional study. BMC Geriatr 2022; 22:994. [PMID: 36550410 PMCID: PMC9784292 DOI: 10.1186/s12877-022-03612-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The diversity of symptoms associated with Parkinson's and their impact on functioning have led to an increased interest in exploring factors that impact Health-Related Quality of Life (HRQoL). Although the experience of Parkinson's is unique, some symptoms have a greater impact than others, e.g. depression. Moreover, as the risk of Parkinson's increases with age, the financial and public health impact of this condition is likely to increase, particularly within the context of a globally ageing population. In Ireland, research is ongoing in the pursuit of causes and effective treatments for Parkinson's; however, its impact on everyday living, functioning, and HRQoL is largely under-examined. This study aims to describe factors that influence HRQoL for people with Parkinson's (PwP) in one region of Ireland. METHODS A cross-sectional postal survey was conducted among people living with Parkinson's (n = 208) in one area of Ireland. This survey included socio-demographic questions, Nonmotor Symptoms Questionnaire for Parkinson's disease (NMSQuest), the Geriatric Depression Scale (GDS-15), and the Parkinson's disease Questionnaire (PDQ-39). Statistical analysis was conducted using SPSS, IBM version 25 (SPSS Inc., Chicago, II, USA). RESULTS Participants reflected a predominantly older population who were married, and lived in their own homes (91%). Participants diagnosed the longest reported poorer HRQoL regarding mobility, activities of daily living, emotional well-being, social support, cognition, communication domains and overall HRQoL. Lower HRQoL correlated with higher depression scores p < 0.001 and participants in the lower HRQoL cohort experienced 2.25 times more non-motor symptoms (NMSs) than participants with higher HRQoL. Hierarchical multiple linear regression analysis predicted Geriatric Depression Scale (GDS15) score, NMS burden, and years since diagnosis to negatively impact HRQoL. Principal component analysis (PCA) also indicated that for the population in this study, components measuring 1) independence/dependence 2) stigma 3) emotional well-being, and 4) pain were central to explaining core aspects of participants' HRQoL. CONCLUSIONS Findings highlighted the negative impact of longer disease duration, NMS burden, depression, mobility impairments, and perceived dependence on HRQoL for PwP. The positive influence of perceived independence, social engagement along with close supportive relationships were also identified as key components determining HRQoL. Findings emphasised the importance of long-term healthcare commitment to sustaining social and community supports and therapeutic, rehabilitative initiatives to augment HRQoL for PwP.
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Affiliation(s)
- Irene Cassidy
- grid.10049.3c0000 0004 1936 9692Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, Ageing Research Centre, University of Limerick, Limerick, Ireland
| | - Owen Doody
- grid.10049.3c0000 0004 1936 9692Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, Ageing Research Centre, University of Limerick, Limerick, Ireland
| | - Pauline Meskell
- grid.10049.3c0000 0004 1936 9692Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, Ageing Research Centre, University of Limerick, Limerick, Ireland
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Harro CC, Shoemaker MJ, Coatney CM, Lentine VE, Lieffers LR, Quigley JJ, Rollins SG, Stewart JD, Hall J, Khoo SK. Effects of nordic walking exercise on gait, motor/non-motor symptoms, and serum brain-derived neurotrophic factor in individuals with Parkinson's disease. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1010097. [PMID: 36311206 PMCID: PMC9614339 DOI: 10.3389/fresc.2022.1010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022]
Abstract
Objective The primary purpose of this study was to investigate the immediate and long-term effects of Nordic Walking (NW) exercise on walking function, motor/non-motor Parkinson's Disease (PD) symptoms, and serum brain-derived neurotrophic factor (BDNF) in persons with idiopathic PD. Methods Twelve community-dwelling participants with mild to moderate idiopathic PD and varied degrees of gait dysfunction were recruited for this prospective, repeated measures design that examined clinical measures and BDNF levels at baseline (T0), post-intervention (T1) and 3-month follow-up (T2). Participants engaged in 6 weeks of supervised NW exercise training with individualized instruction, followed by 14 weeks of independent NW exercise with remote coaching. Outcome measurements included daily step counts, 6-Minute Walk Test (6-MinWT), 10-Meter Walk Test (10MWT), spatiotemporalparameters, Timed Up and Go Test (TUG), dual-task TUG, Revised-Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Revised-Freezing of Gait Questionnaire, MDS-Nonmotor Symptom scale (NMS), Parkinson's Fatigue Scale, and serum BDNF levels. The Friedman test with post hoc Wilcoxon sign-ranked pairwise comparisons were used to compare baseline to T1, baseline to T2, and T1 to T2 timepoints with a Benjamini-Hockberg correction applied. Results Statistically significant improvements found post-training and retained at 3-month follow-up included 6-MinWT, daily step count, 10mWT, MDS-UPDRS, and TUG with effect sizes of 0.57 to 1.03. Serum BDNF at T2 was significantly greater than T0 and T1. Although no statistically significant improvements were observed in the MDS-NMS, 9 of 12 participants had improved non-motor symptoms. There was good adherence, sustained independent exercise engagement, and no adverse events over the 5-month study duration. Conclusions This study demonstrated that NW exercise was a safe, feasible, and sustainable mode of aerobic exercise for this sample of participants with varied Parkinson's disease duration and severity. Following an individualized and progressive NW training intervention, significant improvements in walking function, daily activity level, and motor function were observed. Following the supervised NW training phase, independent three-month engagement in NW exercise was sustained with long-term retention of these clinical improvements and an increase in serum BDNF levels over this five-month NW exercise trial. Impact Nordic walking exercise may be a safe, feasible and sustainable mode of independent exercise for improving daily ambulatory activity, gait and motor function, and serum BDNF in individuals with mild to moderate PD with varied gait abilities. Clinical Trials Registry ID 20-101-H.
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Affiliation(s)
- Cathy C. Harro
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States,Correspondence: Cathy Harro
| | - Michael J Shoemaker
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Cassandra M. Coatney
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Valerie E. Lentine
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Lillian R. Lieffers
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Jessica J. Quigley
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Shannon G. Rollins
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Jonathan D. Stewart
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Julie Hall
- Department of Medical Laboratory Science, Grand Valley State University, Grand Rapids, MI, United States
| | - Sok Kean Khoo
- Department of Cell and Molecular Biology, Grand Valley State University, Grand Rapids, MI, United States
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Clinical Features of Parkinson’s Disease in Patients with Early-Onset Freezing of Gait. PARKINSON'S DISEASE 2022; 2022:4732020. [PMID: 35844832 PMCID: PMC9286965 DOI: 10.1155/2022/4732020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 05/30/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022]
Abstract
Background. Freezing of gait (FOG) is an important symptom that can impair activities of daily living in patients with Parkinson’s disease (PD). However, its pathogenic mechanism is largely unknown. The aim of the present study was to elucidate the clinical characteristics of newly diagnosed and levodopa-naïve patients with PD who present with FOG. Methods. A total of 53 patients with untreated PD (29 men and 24 women) within 2 years of disease onset were included in the study. Using item 3 of the Freezing of Gait Questionnaire (FOG-Q), patients were classified as “freezers” and “nonfreezers” and compared for cognitive function, depressive symptoms, apathy, olfactory function, motor severity, gait parameters, and daily physical activity. We also assessed the relationship between FOG severity (total score of items 3–6 on the FOG-Q) and various clinical parameters. Results. The FOG was reported by 8 (15%) patients with PD. The Apathy Scale score (
), Modified Hoehn and Yahr stage (
), Unified Parkinson’s Disease Rating Scale part III score (
), and postural instability and gait disorder score (
) were significantly higher, and the mean gait acceleration amplitude (
) was significantly lower in freezers compared to that in nonfreezers. However, there was no significant correlation between FOG severity and these clinical parameters. There was also no significant difference in cognitive function, depressive symptoms, and olfactory function between the two groups. Daily physical activity was significantly lower in freezers than that in nonfreezers. Conclusions. Since FOG develops soon after PD onset, the study findings suggest that the FOG might be associated with the severity of apathy, motor symptoms, and in particular, gait disturbance.
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Liu J, Yin W, Zhou C, Zhu Y, Gu M, Liu B, Ren H, Yang X. Association between levels of high-sensitivity C-reactive protein in plasma and freezing of gait in Parkinson's disease. Aging Clin Exp Res 2022; 34:1865-1872. [PMID: 35471697 DOI: 10.1007/s40520-022-02134-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
This study explored the potential relationship between levels of high-sensitivity C-reactive protein (hs-CRP) in plasma and freezing of gait (FOG) in Parkinson's disease (PD) in China. A total of 72 healthy subjects, 62 PD patients with FOG, and 83 PD patients without FOG from our center were enrolled in this prospective study. Patients with FOG showed significantly higher hs-CRP levels than controls, but patients without FOG did not. Binary logistic regression analysis identified levels of hs-CRP in plasma to be an independent risk factor for FOG among the patients in our cohort (OR 6.371, 95% CI 2.589-15.678, p < 0.001). In fact, a cut-off level of 0.935 mg/L distinguished patients with or without FOG [area under the ROC curve (AUC) = 0.908, sensitivity 87.1%, specificity 89.2%]. Our study suggests that high levels of hs-CRP in plasma are associated with the occurrence of FOG in PD. The pooled data combined with a previous study carried out in Spain also indicate a positive association between plasma hs-CRP levels and FOG in PD. However, more research is still needed to verify the plasma hs-CRP as a potential biomarker of FOG.
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Affiliation(s)
- Jie Liu
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, People's Republic of China
- Department of Neurology, Zhenkang County People's Hospital, Lincang, 677704, Yunnan, People's Republic of China
| | - Weifang Yin
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, People's Republic of China
| | - Chuanbin Zhou
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, People's Republic of China
| | - Yangfan Zhu
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, People's Republic of China
- Yunnan Province Clinical Research Center for Gerontology, Kunming, 650032, Yunnan, People's Republic of China
| | - Meijuan Gu
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, People's Republic of China
- Yunnan Province Clinical Research Center for Gerontology, Kunming, 650032, Yunnan, People's Republic of China
| | - Bin Liu
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, People's Republic of China
- Yunnan Province Clinical Research Center for Gerontology, Kunming, 650032, Yunnan, People's Republic of China
| | - Hui Ren
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, People's Republic of China
- Yunnan Province Clinical Research Center for Gerontology, Kunming, 650032, Yunnan, People's Republic of China
| | - Xinglong Yang
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, People's Republic of China.
- Yunnan Province Clinical Research Center for Gerontology, Kunming, 650032, Yunnan, People's Republic of China.
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9
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Cui CK, Lewis SJG. Future Therapeutic Strategies for Freezing of Gait in Parkinson's Disease. Front Hum Neurosci 2021; 15:741918. [PMID: 34795568 PMCID: PMC8592896 DOI: 10.3389/fnhum.2021.741918] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/05/2021] [Indexed: 12/28/2022] Open
Abstract
Freezing of gait (FOG) is a common and challenging clinical symptom in Parkinson’s disease. In this review, we summarise the recent insights into freezing of gait and highlight the strategies that should be considered to improve future treatment. There is a need to develop individualised and on-demand therapies, through improved detection and wearable technologies. Whilst there already exist a number of pharmacological (e.g., dopaminergic and beyond dopamine), non-pharmacological (physiotherapy and cueing, cognitive training, and non-invasive brain stimulation) and surgical approaches to freezing (i.e., dual-site deep brain stimulation, closed-loop programming), an integrated collaborative approach to future research in this complex area will be necessary to systematically investigate new therapeutic avenues. A review of the literature suggests standardising how gait freezing is measured, enriching patient cohorts for preventative studies, and harnessing the power of existing data, could help lead to more effective treatments for freezing of gait and offer relief to many patients.
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Affiliation(s)
- Cathy K Cui
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, The University of Sydney, Camperdown, NSW, Australia
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10
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Zhang F, Shi J, Duan Y, Cheng J, Li H, Xuan T, Lv Y, Wang P, Li H. Clinical features and related factors of freezing of gait in patients with Parkinson's disease. Brain Behav 2021; 11:e2359. [PMID: 34551452 PMCID: PMC8613420 DOI: 10.1002/brb3.2359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/10/2021] [Accepted: 08/18/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Freezing of gait (FOG) is a disabling paroxysmal gait disorder that prevents starting or resuming walking, which seriously negatively affects patients' quality of life (QOL). The diagnosis and treatment of FOG remain a huge medical challenge. The purpose of this study was to explore the clinical characteristics and related factors of FOG in patients with Parkinson's disease (PD). METHODS The motor and nonmotor symptoms of a total number of 77 PD patients were evaluated. Patients with or without FOG were defined as a score ≥1 in the new freezing of gait questionnaire (NFOG-Q). A comparative study between patients with and without FOG was conducted. RESULTS In this investigation, the prevalence of FOG was 48%. The patients with FOG had longer disease duration, higher Hoehn-Yahr stage (H-Y stage), higher dose of dopaminergic agents, and higher nonmotor and motor symptom scores. A significant positive correlation was found between the NFOG-Q score and the H-Y stage, PIGD subscore, PDQ-39, and the attention/memory in the nonmotor symptoms assessment scale (NMSS) subitem (r > 0.5, p < .05). The binary logistic regression analysis showed that the higher H-Y stage, higher rigidity subscore and Unified Parkinson's Disease Rating Scale II (UPDRS II) score, and UPDRS III score were significantly correlated with the occurrence of FOG (p < .05). In the analysis of the frequency of FOG, the prevalence of FOG in H-Y stage was higher in the middle and late stages, and the prevalence of FOG increased with the increase in PDQ-39 scores. CONCLUSION The severity of FOG was significantly positively correlated with the H-Y stage, PIGD subscore, PDQ-39 score, and attention/memory score. Based on our findings, we conclude that the clinical characteristics of rigidity can be used as a potential predictor of FOG.
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Affiliation(s)
- Fengting Zhang
- School of Clinical MedicineNingxia Medical UniversityYinchuanChina
- Department of NeurologyGeneral Hospital of Ningxia Medical UniversityNingxia Key Laboratory of Cerebrocranial DiseasesIncubation Base of National Key LaboratoryYinchuanChina
| | - Jin Shi
- School of Clinical MedicineNingxia Medical UniversityYinchuanChina
- Department of NeurologyGeneral Hospital of Ningxia Medical UniversityNingxia Key Laboratory of Cerebrocranial DiseasesIncubation Base of National Key LaboratoryYinchuanChina
| | - Yangyang Duan
- School of Clinical MedicineNingxia Medical UniversityYinchuanChina
- Department of NeurologyGeneral Hospital of Ningxia Medical UniversityNingxia Key Laboratory of Cerebrocranial DiseasesIncubation Base of National Key LaboratoryYinchuanChina
| | - Jiang Cheng
- Department of NeurologyGeneral Hospital of Ningxia Medical UniversityNingxia Key Laboratory of Cerebrocranial DiseasesIncubation Base of National Key LaboratoryYinchuanChina
| | - Hui Li
- Department of Computer ScienceJiangsu Ocean UniversityLianyungangChina
| | - Tingting Xuan
- School of Clinical MedicineNingxia Medical UniversityYinchuanChina
- Department of NeurologyGeneral Hospital of Ningxia Medical UniversityNingxia Key Laboratory of Cerebrocranial DiseasesIncubation Base of National Key LaboratoryYinchuanChina
| | - Yue Lv
- School of Clinical MedicineNingxia Medical UniversityYinchuanChina
- Department of NeurologyGeneral Hospital of Ningxia Medical UniversityNingxia Key Laboratory of Cerebrocranial DiseasesIncubation Base of National Key LaboratoryYinchuanChina
| | - Peng Wang
- School of Clinical MedicineNingxia Medical UniversityYinchuanChina
- Department of NeurologyGeneral Hospital of Ningxia Medical UniversityNingxia Key Laboratory of Cerebrocranial DiseasesIncubation Base of National Key LaboratoryYinchuanChina
| | - Haining Li
- Department of NeurologyGeneral Hospital of Ningxia Medical UniversityNingxia Key Laboratory of Cerebrocranial DiseasesIncubation Base of National Key LaboratoryYinchuanChina
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Prevalence of freezing of gait in Parkinson's disease: a systematic review and meta-analysis. J Neurol 2021; 268:4138-4150. [PMID: 34236501 DOI: 10.1007/s00415-021-10685-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Freezing of gait (FOG) is considered one of the most disturbing and least understood symptoms in Parkinson's disease (PD). The reported prevalence rates of FOG in PD vary widely, ranging from 5 to 85.9%. OBJECTIVE We conducted a systematic review and meta-analysis to provide a reliable estimate of the average point prevalence of FOG in PD, and we further investigated the study characteristics that might have influenced the estimate. METHODS We searched different databases to identify studies that report the prevalence of FOG in PD or include relevant raw data for further calculation. The last inclusion date was February 20, 2020. The modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used for the quality assessment, and articles that met the predefined criteria were included in the quantitative analysis. RESULTS Sixty-six studies were selected from 3392 references. A weighted prevalence of 50.6% in 9072 PD patients experienced FOG based on the special questionnaires (the FOG-Q and NFOG-Q), which was about twice as high as that assessed by the specific items of the clinical rating scales (UPDRS item2.14 and MDS-UPDRS item3.11) (23.2%) or simple clinical questions (25.4%). The weighted prevalence was 37.9% for early stage (≤ 5 years) and 64.6% for advanced stage (≥ 9 years). Moreover, a higher prevalence was calculated from the population-based studies than that in multicenter and single-center studies (47.3% vs. 33.5% and 37.1%, respectively). CONCLUSION The result from this systematic review confirms that FOG is very common in PD and its prevalence is usually underestimated in hospital settings. Importantly, a more accurate assessment of FOG in future clinical researches would involve the use of special FOG scale rather than a single item on a scale or a general clinical inquiry.
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12
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Santos-García D, de Deus T, Cores C, Canfield H, Paz González JM, Martínez Miró C, Valdés Aymerich L, Suárez E, Jesús S, Aguilar M, Pastor P, Planellas L, Cosgaya M, García Caldentey J, Caballol N, Legarda I, Hernández-Vara J, Cabo I, López Manzanares L, González Aramburu I, Ávila Rivera MA, Catalán MJ, Nogueira V, Puente V, Dotor J, Borrué C, Solano B, Álvarez Sauco M, Vela L, Escalante S, Cubo E, Carrillo F, Martínez Castrillo JC, Sánchez Alonso P, Alonso G, López Ariztegui N, Gastón I, Kulisevsky J, Blázquez M, Seijo M, Rúiz Martínez J, Valero C, Kurtis M, de Fábregues O, Ardura J, Alonso R, Ordás C, López Díaz LM, McAfee D, Martinez-Martin P, Mir P. Predictors of Global Non-Motor Symptoms Burden Progression in Parkinson's Disease. Results from the COPPADIS Cohort at 2-Year Follow-Up. J Pers Med 2021; 11:626. [PMID: 34209166 PMCID: PMC8305732 DOI: 10.3390/jpm11070626] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background and Objective: Non-motor symptoms (NMS) progress in different ways between Parkinson's disease (PD) patients. The aim of the present study was to (1) analyze the change in global NMS burden in a PD cohort after a 2-year follow-up, (2) to compare the changes with a control group, and (3) to identify predictors of global NMS burden progression in the PD group. Material and Methods: PD patients and controls, recruited from 35 centers of Spain from the COPPADIS cohort from January 2016 to November 2017, were followed-up with after 2 years. The Non-Motor Symptoms Scale (NMSS) was administered at baseline (V0) and at 24 months ± 1 month (V2). Linear regression models were used for determining predictive factors of global NMS burden progression (NMSS total score change from V0 to V2 as dependent variable). Results: After the 2-year follow-up, the mean NMS burden (NMSS total score) significantly increased in PD patients by 18.8% (from 45.08 ± 37.62 to 53.55 ± 42.28; p < 0.0001; N = 501; 60.2% males, mean age 62.59 ± 8.91) compared to no change observed in controls (from 14.74 ± 18.72 to 14.65 ± 21.82; p = 0.428; N = 122; 49.5% males, mean age 60.99 ± 8.32) (p < 0.0001). NMSS total score at baseline (β = -0.52), change from V0 to V2 in PDSS (Parkinson's Disease Sleep Scale) (β = -0.34), and change from V0 to V2 in NPI (Neuropsychiatric Inventory) (β = 0.25) provided the highest contributions to the model (adjusted R-squared 0.41; Durbin-Watson test = 1.865). Conclusions: Global NMS burden demonstrates short-term progression in PD patients but not in controls and identifies worsening sleep problems and neuropsychiatric symptoms as significant independent predictors of this NMS progression.
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Affiliation(s)
- Diego Santos-García
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (C.C.); (J.M.P.G.); (C.M.M.); (L.V.A.)
| | - Teresa de Deus
- CHUF, Complejo Hospitalario Universitario de Ferrol, 15405 A Coruña, Spain; (T.d.D.); (H.C.); (E.S.)
| | - Carlos Cores
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (C.C.); (J.M.P.G.); (C.M.M.); (L.V.A.)
| | - Hector Canfield
- CHUF, Complejo Hospitalario Universitario de Ferrol, 15405 A Coruña, Spain; (T.d.D.); (H.C.); (E.S.)
| | - Jose M Paz González
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (C.C.); (J.M.P.G.); (C.M.M.); (L.V.A.)
| | - Cristina Martínez Miró
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (C.C.); (J.M.P.G.); (C.M.M.); (L.V.A.)
| | - Lorena Valdés Aymerich
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (C.C.); (J.M.P.G.); (C.M.M.); (L.V.A.)
| | - Ester Suárez
- CHUF, Complejo Hospitalario Universitario de Ferrol, 15405 A Coruña, Spain; (T.d.D.); (H.C.); (E.S.)
| | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41009 Seville, Spain; (S.J.); (P.M.)
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
| | - Miquel Aguilar
- Hospital Universitari Mutua de Terrassa, 08221 Barcelona, Spain; (M.A.); (P.P.)
| | - Pau Pastor
- Hospital Universitari Mutua de Terrassa, 08221 Barcelona, Spain; (M.A.); (P.P.)
| | - Lluis Planellas
- Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (L.P.); (M.C.)
| | - Marina Cosgaya
- Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (L.P.); (M.C.)
| | | | - Nuria Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, 08970 Barcelona, Spain;
| | - Ines Legarda
- Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain;
| | - Jorge Hernández-Vara
- Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain; (J.H.-V.); (O.d.F.)
| | - Iria Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), 36071 Pontevedra, Spain; (I.C.); (M.S.)
| | | | - Isabel González Aramburu
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
- Hospital Universitario Marqués de Valdecilla, 39011 Santander, Spain
| | - Maria A Ávila Rivera
- Consorci Sanitari Integral, Hospital General de L’Hospitalet, 08906 Barcelona, Spain;
| | - Maria J Catalán
- Hospital Universitario Clínico San Carlos, 28040 Madrid, Spain;
| | | | | | - Julio Dotor
- Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain;
| | | | - Berta Solano
- Institut d’Assistència Sanitària (IAS)—Institut Català de la Salut, 17190 Girona, Spain;
| | | | - Lydia Vela
- Fundación Hospital de Alcorcón, 28922 Madrid, Spain;
| | - Sonia Escalante
- Hospital de Tortosa Verge de la Cinta (HTVC), 43500 Tarragona, Spain;
| | - Esther Cubo
- Complejo Asistencial Universitario de Burgos, 09006 Burgos, Spain;
| | - Francisco Carrillo
- Hospital Universitario de Canarias, 38320 San Cristóbal de la Laguna, Spain;
| | | | | | - Gemma Alonso
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), 36213 Vigo, Spain;
| | | | - Itziar Gastón
- Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
| | - Jaime Kulisevsky
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
- Hospital de Sant Pau, 08041 Barcelona, Spain
| | - Marta Blázquez
- Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
| | - Manuel Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), 36071 Pontevedra, Spain; (I.C.); (M.S.)
| | | | | | | | - Oriol de Fábregues
- Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain; (J.H.-V.); (O.d.F.)
| | | | - Ruben Alonso
- Hospital Universitario Lucus Augusti (HULA), 27002 Lugo, Spain;
| | | | - Luis M López Díaz
- Complejo Hospitalario Universitario de Orense (CHUO), 32005 Orense, Spain;
| | - Darrian McAfee
- Laboratory for Cognition and Neural Stimulation, Univeristy of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Pablo Martinez-Martin
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41009 Seville, Spain; (S.J.); (P.M.)
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
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Chen ZY, Yan HJ, Qi L, Zhen QX, Liu C, Wang P, Liu YH, Wang RD, Liu YJ, Fang JP, Su Y, Yan XY, Liu AX, Xi J, Fang B. C-Gait for Detecting Freezing of Gait in the Early to Middle Stages of Parkinson's Disease: A Model Prediction Study. Front Hum Neurosci 2021; 15:621977. [PMID: 33828470 PMCID: PMC8019899 DOI: 10.3389/fnhum.2021.621977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/12/2021] [Indexed: 12/28/2022] Open
Abstract
Objective Efficient methods for assessing walking adaptability in individuals with Parkinson's disease (PD) are urgently needed. Therefore, this study aimed to assess C-Gait for detecting freezing of gait (FOG) in patients with early- to middle-stage PD. Method People with PD (PWP) diagnosis (Hoehn and Yahr stages 1-3) were recruited from April 2019 to November 2019 in Beijing Rehabilitation Hospital. The participants performed six items of walking adaptability on an instrumented treadmill augmented with visual targets and obstacles (C-Mill). The patient's walking adaptability was evaluated by C-Gait assessment and traditional walking tests, and FOG-related indexes were collected as outcome measures. Two discriminant models were established by stepwise discriminant analysis; area under the receiver operating characteristic (ROC) curve (AUC) was used to validate the models. Result In total, 53 patients were included in this study. Most C-Gait assessment items had no or low correlations with traditional walking tests. The obstacle avoidance (r = -0.639, P = 0.003) and speed of adaptation (r = -0.486, P = 0.035) items could lead to FOG with high sensitivity. In addition, the C-Gait assessment model (AUC = 0.755) had slightly better discrimination of freezers from non-freezers compared with traditional walking test models (AUC = 0.672); specifically, obstacle avoidance and speed of adaptation have uniquely discriminant potential. Conclusion C-gait assessment could provide additional value to the traditional walking tests for PD. Gait adaptability assessment, as measured by C-Gait, may be able to help identify freezers in a PD population.
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Affiliation(s)
- Zi-Yan Chen
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Hong-Jiao Yan
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Lin Qi
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Qiao-Xia Zhen
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Cui Liu
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Ping Wang
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yong-Hong Liu
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Rui-Dan Wang
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yan-Jun Liu
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jin-Ping Fang
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yuan Su
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Xiao-Yan Yan
- Peking University Clinical Research Institute, Beijing, China
| | - Ai-Xian Liu
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jianing Xi
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Boyan Fang
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
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Aktürk T, Güven H, Güven B, Çomoğlu S. Association of freezing of gait and clinical features in patients with Parkinson's disease. Acta Neurol Belg 2021; 121:153-159. [PMID: 31654392 DOI: 10.1007/s13760-019-01217-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
Freezing of gait (FOG) is a disabling symptom that affects the quality of life of patients with Parkinson's disease (PD) and its pathophysiology is not fully understood yet. The aim of the present study is to evaluate the relationship between FOG and other clinical characteristics in patients with PD. The clinical characteristics, modified Hoehn and Yahr (mHY) stages, Unified Parkinson's Disease Rating Scale (UPDRS) scores, and total Freezing of Gait Questionnaire (FOG-Q) scores of the patients with PD were recorded. FOG-Q item 1.3 was used to evaluate patients with or without FOG. A total of 65 patients with PD (32 with FOG and 33 without FOG) were included to the study. Disease duration was longer, mHY stages were higher, bradykinesia and dyskinesia were more common in patients with FOG compared to patients without (p = 0.001, p = 0.036, p = 0.019 and p = 0.021; respectively). Patients with FOG had lower UPDRS part III tremor subscores (p = 0.020), although gait, postural balance subscores and part IV motor fluctuations scores were higher (p = 0.003, p = 0.023 and p < 0.001; respectively). A positive correlation was found between FOG-Q scores and mHY stages (p < 0.001), UPDRS part II and III total scores (p = 0.020 and p = 0.001) and part III bradykinesia, and gait and postural balance subscores (p = 0.003, p = 0.036 and p = 0.003, respectively), and part IV motor fluctuation scores (p = 0.006). The results of the present study point to an association between FOG and bradykinesia rather than tremor, prolonged disease duration and advanced disease stage reflecting its association with more severe and extensive neurodegenerative processes.
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15
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Freezing of Gait in Parkinson's Disease: Risk Factors, Their Interactions, and Associated Nonmotor Symptoms. PARKINSONS DISEASE 2021; 2021:8857204. [PMID: 33505652 PMCID: PMC7815408 DOI: 10.1155/2021/8857204] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/22/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
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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16
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Choi SM, Cho SH, Kim BC. Association between freezing of gait and bone mineral density in patients with Parkinson's disease. Neurol Sci 2020; 42:2921-2925. [PMID: 33230756 DOI: 10.1007/s10072-020-04920-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/16/2020] [Indexed: 11/27/2022]
Abstract
Parkinson's disease (PD) patients are at risk for developing bone health problems, and freezing of gait (FOG) in PD is associated with a high risk of falling and fracture. This study aimed to determine the association between FOG and bone mineral density (BMD) in patients with PD. We included 148 PD patients. FOG was assessed using the FOG Questionnaire (FOG-Q), and BMD was measured by dual-energy X-ray absorptiometry. Of 148 PD patients, 102 (68.9%) had FOG. PD patients with FOG were older and had longer disease duration, higher levodopa equivalent dose, higher modified Hoehn and Yahr stage, higher Unified PD Rating Scale motor score, higher FOG-Q score, higher total Non-Motor Symptom Scale score, and lower BMD scores in the femoral neck area than those without FOG. Pearson correlation analysis revealed that age, sex, body mass index, and age at onset were significantly correlated with areal BMDs in all areas. FOG-Q scores correlated negatively with areal BMDs in the total hip area and femoral neck, but not with areal BMD in the lumbar spine. Multivariate regression analysis showed that FOG-Q score was significantly correlated with areal BMD in the femoral neck, but not with areal BMDs in the lumbar spine or total hip. FOG in PD patients correlates significantly with BMD in the femoral neck area. Therefore, PD patients with FOG should be screened for osteoporosis.
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Affiliation(s)
- Seong-Min Choi
- Department of Neurology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 58128, South Korea
- National Research Center for Dementia, Gwangju, South Korea
| | - Soo Hyun Cho
- Department of Neurology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 58128, South Korea
| | - Byeong C Kim
- Department of Neurology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 58128, South Korea.
- National Research Center for Dementia, Gwangju, South Korea.
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Hardeman LES, Kal EC, Young WR, van der Kamp J, Ellmers TJ. Visuomotor control of walking in Parkinson's disease: Exploring possible links between conscious movement processing and freezing of gait. Behav Brain Res 2020; 395:112837. [PMID: 32739286 DOI: 10.1016/j.bbr.2020.112837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/10/2020] [Accepted: 07/24/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Changes in visual attention have been argued to influence freezing of gait (FOG) in people with Parkinson's Disease (PD). However, the specific visual search patterns of people with FOG pathology (PD + FOG) and potential underlying mechanisms are not well understood. The current study explored visual search behavior in PD + FOG while walking on a pathway featuring environmental features known to exacerbate FOG (e.g., narrow doorway and tripping hazards). Potential underpinning attentional mechanisms were also assessed, such as conscious movement processing. METHODS Visual search behavior of twelve people with PD + FOG tested in ON-state (Mage = 74.3) and twelve age-matched healthy controls (Mage = 72.5) were analyzed during a complex walking task. The task required participants to step over an obstacle and navigate through a narrow doorway, surrounded by clutter. RESULTS People with PD + FOG more frequently directed visual attention to ongoing and imminent steps compared to healthy controls (Mdn = 26% vs Mdn = 14%, respectively; p = 0.042). Self-reported conscious movement processing was also significantly higher in people with PD + FOG. The one participant who froze during the walking task fixated the future trip hazard (obstacle, approximately 6 steps ahead) almost exclusively during freezing trials (i.e., 60-100% of the trial). In contrast, during 'non-freeze' trials, this participant increased the duration of fixations towards ongoing and imminent steps. CONCLUSION Results suggest that people with PD + FOG strongly monitor/control ongoing and immediately upcoming stepping movements. However, prolonged fixations towards threats to future movements might prevent people with PD + FOG from processing the visual information needed to do this, thereby provoke freezing episodes.
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Affiliation(s)
- L E S Hardeman
- Faculty of Behavioral and Movement Sciences, VU University Amsterdam, Netherlands; College of Health, Medicine and Life Sciences, Brunel University London, UK
| | - E C Kal
- College of Health, Medicine and Life Sciences, Brunel University London, UK; Centre for Cognitive Neuroscience, Brunel University London, UK
| | - W R Young
- College of Health, Medicine and Life Sciences, Brunel University London, UK; School of Sport and Health Sciences, University of Exeter, UK
| | - J van der Kamp
- Faculty of Behavioral and Movement Sciences, VU University Amsterdam, Netherlands
| | - T J Ellmers
- College of Health, Medicine and Life Sciences, Brunel University London, UK; Centre for Cognitive Neuroscience, Brunel University London, UK.
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Using Kinect v2 to Control a Laser Visual Cue System to Improve the Mobility during Freezing of Gait in Parkinson's Disease. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:3845462. [PMID: 30915207 PMCID: PMC6402218 DOI: 10.1155/2019/3845462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/03/2019] [Accepted: 01/22/2019] [Indexed: 12/05/2022]
Abstract
Different auditory and visual cues have been proven to be very effective in improving the mobility of people with Parkinson's (PwP). Nonetheless, many of the available methods require user intervention and so on to activate the cues. Moreover, once activated, these systems would provide cues continuously regardless of the patient's needs. This research proposes a new indoor method for casting dynamic/automatic visual cues for PwP based on their head direction and location in a room. The proposed system controls the behavior of a set of pan/tilt servo motors and laser pointers, based on the real-time skeletal information acquired from a Kinect v2 sensor. This produces an automatically adjusting set of laser lines that can always be in front of the patient as a guideline for where the next footstep would be placed. A user interface was also created that enables users to control and adjust the settings based on the preferences. The aim of this research was to provide PwP with an unobtrusive/automatic indoor system for improving their mobility during a Freezing of gait (FOG) incident. The results showed the possibility of employing such system, which does not rely on the subject's input nor does it introduce any additional complexities to operate.
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