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Zhao M, Pang H, Li X, Bu S, Wang J, Liu Y, Jiang Y, Fan G. Low and high-order topological disruption of functional networks in multiple system atrophy with freezing of gait: A resting-state study. Neurobiol Dis 2024; 195:106504. [PMID: 38615913 DOI: 10.1016/j.nbd.2024.106504] [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: 02/08/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/16/2024] Open
Abstract
OBJECTIVE Freezing of gait (FOG), a specific survival-threatening gait impairment, needs to be urgently explored in patients with multiple system atrophy (MSA), which is characterized by rapid progression and death within 10 years of symptom onset. The objective of this study was to explore the topological organisation of both low- and high-order functional networks in patients with MAS and FOG. METHOD Low-order functional connectivity (LOFC) and high-order functional connectivity FC (HOFC) networks were calculated and further analysed using the graph theory approach in 24 patients with MSA without FOG, 20 patients with FOG, and 25 healthy controls. The relationship between brain activity and the severity of freezing symptoms was investigated in patients with FOG. RESULTS Regarding global topological properties, patients with FOG exhibited alterations in the whole-brain network, dorsal attention network (DAN), frontoparietal network (FPN), and default network (DMN), compared with patients without FOG. At the node level, patients with FOG showed decreased nodal centralities in sensorimotor network (SMN), DAN, ventral attention network (VAN), FPN, limbic regions, hippocampal network and basal ganglia network (BG), and increased nodal centralities in the FPN, DMN, visual network (VIN) and, cerebellar network. The nodal centralities of the right inferior frontal sulcus, left lateral amygdala and left nucleus accumbens (NAC) were negatively correlated with the FOG severity. CONCLUSION This study identified a disrupted topology of functional interactions at both low and high levels with extensive alterations in topological properties in MSA patients with FOG, especially those associated with damage to the FPN. These findings offer new insights into the dysfunctional mechanisms of complex networks and suggest potential neuroimaging biomarkers for FOG in patients with MSA.
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Affiliation(s)
- Mengwan Zhao
- Department of radiology, the first hospital of China medical University,Shenyang, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China.
| | - Huize Pang
- Department of radiology, the first hospital of China medical University,Shenyang, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China.
| | - Xiaolu Li
- Department of radiology, the first hospital of China medical University,Shenyang, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China.
| | - Shuting Bu
- Department of radiology, the first hospital of China medical University,Shenyang, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China.
| | - Juzhou Wang
- Department of radiology, the first hospital of China medical University,Shenyang, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China.
| | - Yu Liu
- Department of radiology, the first hospital of China medical University,Shenyang, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China.
| | - Yueluan Jiang
- MR Research Collaboration, Siemens Healthineers, Beijing 7 Wangjing Zhonghuan Nanlu, Chaoyang District, Beijing 100102, PR China.
| | - Guoguang Fan
- Department of radiology, the first hospital of China medical University,Shenyang, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China.
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Chen Y, Wang H, Huang H, Chen Y, Xu Y. Freezing of gait in Chinese patients with multiple system atrophy: prevalence and risk factors. Front Neurosci 2023; 17:1194904. [PMID: 37351425 PMCID: PMC10282176 DOI: 10.3389/fnins.2023.1194904] [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: 03/27/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Abstract
Objective Freezing of gait (FOG) is common in neurodegenerative forms of atypical parkinsonism, but few studies have examined FOG in multiple system atrophy (MSA). In this study, we examined the prevalence of freezing of gait and its relationship to clinical features in a large cohort of Chinese MSA patients. Methods This exploratory study included 202 Chinese patients with probable MSA. FOG was defined as a score ≥ 1 on item 14 of the Unified Parkinson's Disease Rating Scale. Patients with or without FOG were compared in terms of the Unified MSA Rating Scale (UMSARS) as well as cognitive and neuropsychiatric assessments. Results The frequency of FOG was 48.0, 52.1, and 38.7% in MSA, MSA with predominant parkinsonism (MSA-P), and MSA with predominant cerebellar ataxia (MSA-C), respectively. FOG was associated with worse subscores on parts I, II and IV of the UMSARS as well as worse total UMSARS score; greater likelihood of speech difficulties, falls, gait impairment and balance disorder; more severe symptoms of anxiety and depression; and lower activities of daily living. The binary logistic regression model indicated that higher total UMSARS scores were associated with FOG in MSA, MSA-P, and MSA-C patients. Conclusion Freezing of gait may be common among Chinese MSA patients, FOG may correlate with severe motor symptoms, anxiety, depression and activities of daily living. Total UMSARS score may be an independent risk factor for FOG.
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Affiliation(s)
- Yalan Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hui Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongyan Huang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanming Xu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Cockx H, Nonnekes J, Bloem B, van Wezel R, Cameron I, Wang Y. Dealing with the heterogeneous presentations of freezing of gait: how reliable are the freezing index and heart rate for freezing detection? J Neuroeng Rehabil 2023; 20:53. [PMID: 37106388 PMCID: PMC10134593 DOI: 10.1186/s12984-023-01175-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Freezing of gait (FOG) is an unpredictable gait arrest that hampers the lives of 40% of people with Parkinson's disease. Because the symptom is heterogeneous in phenotypical presentation (it can present as trembling/shuffling, or akinesia) and manifests during various circumstances (it can be triggered by e.g. turning, passing doors, and dual-tasking), it is particularly difficult to detect with motion sensors. The freezing index (FI) is one of the most frequently used accelerometer-based methods for FOG detection. However, it might not adequately distinguish FOG from voluntary stops, certainly for the akinetic type of FOG. Interestingly, a previous study showed that heart rate signals could distinguish FOG from stopping and turning movements. This study aimed to investigate for which phenotypes and evoking circumstances the FI and heart rate might provide reliable signals for FOG detection. METHODS Sixteen people with Parkinson's disease and daily freezing completed a gait trajectory designed to provoke FOG including turns, narrow passages, starting, and stopping, with and without a cognitive or motor dual-task. We compared the FI and heart rate of 378 FOG events to baseline levels, and to stopping and normal gait events (i.e. turns and narrow passages without FOG) using mixed-effects models. We specifically evaluated the influence of different types of FOG (trembling vs akinesia) and triggering situations (turning vs narrow passages; no dual-task vs cognitive dual-task vs motor dual-task) on both outcome measures. RESULTS The FI increased significantly during trembling and akinetic FOG, but increased similarly during stopping and was therefore not significantly different from FOG. In contrast, heart rate change during FOG was for all types and during all triggering situations statistically different from stopping, but not from normal gait events. CONCLUSION When the power in the locomotion band (0.5-3 Hz) decreases, the FI increases and is unable to specify whether a stop is voluntary or involuntary (i.e. trembling or akinetic FOG). In contrast, the heart rate can reveal whether there is the intention to move, thus distinguishing FOG from stopping. We suggest that the combination of a motion sensor and a heart rate monitor may be promising for future FOG detection.
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Affiliation(s)
- Helena Cockx
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Heyendaalseweg 135, P.O. Box 9102, 6525AJ, Nijmegen, The Netherlands.
| | - Jorik Nonnekes
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Bastiaan Bloem
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Richard van Wezel
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Heyendaalseweg 135, P.O. Box 9102, 6525AJ, Nijmegen, The Netherlands
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands
| | - Ian Cameron
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands
- OnePlanet Research Center, Nijmegen, The Netherlands
| | - Ying Wang
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Heyendaalseweg 135, P.O. Box 9102, 6525AJ, Nijmegen, The Netherlands
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands
- ZGT Academy, Ziekenhuisgroep Twente, Almelo, The Netherlands
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Cheng Y, Yang H, Liu WV, Wen Z, Chen J. Alterations of brain activity in multiple system atrophy patients with freezing of gait: A resting-state fMRI study. Front Neurosci 2022; 16:954332. [PMID: 36051644 PMCID: PMC9425908 DOI: 10.3389/fnins.2022.954332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Freezing of gait (FOG) in multiple system atrophy (MSA) is characterized by a higher risk of falls and a reduced quality of life; however, the mechanisms underlying these effects have yet to be identified by neuroimaging. The aim of this study was to investigate the differences in functional network when compared between MSA patients with and without freezing. Methods Degree centrality (DC) based on the resting-state functional magnetic resonance imaging was computed in 65 patients with MSA and 36 healthy controls. Brain regions with statistically different DC values between groups were selected as seed points for a second seed-based functional connectivity (FC) analysis. The relationships between brain activity (DC and FC alterations) and the severity of freezing symptoms were then investigated in the two groups of patients with MSA. Results Compared to MSA patients without FOG symptoms (MSA-nFOG), patients with MSA-FOG showed an increased DC in the left middle temporal gyrus but a reduced DC in the right superior pole temporal gyrus, left anterior cingulum cortex, left thalamus, and right middle frontal gyrus. Furthermore, in patients with MSA-FOG, the DC in the left thalamus was negatively correlated with FOG scores. Using the left thalamus as a seed, secondary seed-based functional connectivity analysis revealed that patients with MSA-FOG commonly showed the left thalamus-based FC abnormalities in regions related to cognition and emotion. In contrast to the patients with MSA-nFOG, patients with MSA-FOG showed an increased FC between the left thalamus and the left middle temporal gyrus (MTG), right inferior parietal lobule (IPL), bilateral cerebellum_8, and left precuneus. Conclusion Freezing of gait is associated with centrality of the impaired thalamus network. Abnormal FC between the thalamus and left MTG, right IPL, bilateral cerebellum_8, and left precuneus was involved in FOG. These results provide new insight into the pathophysiological mechanism of FOG in MSA.
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Affiliation(s)
- Yilin Cheng
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huaguang Yang
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | | | - Zhi Wen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Chen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
- *Correspondence: Jun Chen,
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Yang H, Liu WV, Wang S, Yang W, Liu C, Wen Z, Hu L, Guo J, Fan G, Luo X, Zha Y. Freezing of Gait in Multiple System Atrophy. Front Aging Neurosci 2022; 14:833287. [PMID: 35462702 PMCID: PMC9024348 DOI: 10.3389/fnagi.2022.833287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background and PurposeFreezing of gait (FOG) is a common gait disturbance phenomenon in multiple system atrophy (MSA) patients. The current investigation assessed the incidence FOG in a cross-sectional clinical study, and clinical correlations associated with it.MethodsNinety-nine MSA patients from three hospitals in China were consecutively enrolled in the study. Eight patients were subsequently excluded from the analysis due to incomplete information. The prevalence of FOG symptoms in the MSA cohort was determined, and clinical manifestations in MSA patients with and without FOG were assessed.ResultsOf 91 MSA patients, 60 (65.93%) exhibited FOG. The incidence of FOG increased with disease duration and motor severity and was correlated with modified Hoehn and Yahr (H-Y) stages [odds ratio (OR), 0.54; 95% confidence interval (CI), 0.33–3.92], longer disease duration (OR, 0.54, 95% CI, 0.37–0.78), higher Unified Multiple System Atrophy Rating Scale (UMSARS) score (OR, 0.96, 95% CI, 0.93–0.99), MSA-cerebellum subtype (OR, 2.99, 95% CI, 1.22–7.33), levodopa-equivalent dose (LDED) (OR, 0.998, 95% CI, 0.997–1.00), and higher Scale for the Assessment and Rating of Ataxia (SARA) score (OR, 0.80, 95% CI, 0.72–0.89) (logistic regression). Motor dysfunction was significantly positively associated with lower quality of life scores (p < 0.01).ConclusionFOG is a common symptom in MSA patients and it is correlated with poor quality of life, disease progression and severity, levodopa-equivalent dose, and cerebellum impairment.
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Affiliation(s)
- Huaguang Yang
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | | | - Shanshan Wang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wenbin Yang
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Changsheng Liu
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhi Wen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lanhua Hu
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jinxia Guo
- MR Research, GE Healthcare, Beijing, China
| | - Guoguang Fan
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaoguang Luo
- Department of Neurology, The First Affiliated Hospital of South University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, China
- *Correspondence: Xiaoguang Luo,
| | - Yunfei Zha
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
- Yunfei Zha,
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Scholl JL, Espinoza AI, Rai W, Leedom M, Baugh LA, Berg-Poppe P, Singh A. Relationships between Freezing of Gait Severity and Cognitive Deficits in Parkinson's Disease. Brain Sci 2021; 11:brainsci11111496. [PMID: 34827496 PMCID: PMC8615553 DOI: 10.3390/brainsci11111496] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022] Open
Abstract
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 a reduced quality of life. Evidence supports an association between FOG severity and cognitive functioning; however, results remain debatable. PD patients with (PDFOG+, n = 41) and without FOG (PDFOG–, n = 39) and control healthy subjects (n = 41) participated in this study. The NIH toolbox cognition battery, the Montreal Cognitive Assessment (MoCA), and the 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. Significant differences were observed between controls and PD patients for all cognitive domains. PDFOG+ and PDFOG– exhibited differences in 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. Overall, this study provides insight into the relationship between cognitive and FOG severity in patients with PD, which could aid in the development of therapeutic interventions to manage both.
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Affiliation(s)
- Jamie L. Scholl
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA; (J.L.S.); (L.A.B.)
- Center for Brain and Behavior Research, University of South Dakota, Vermillion, SD 57069, USA;
| | | | - Wijdan Rai
- Department of Neurosciences, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 57105, USA;
| | | | - Lee A. Baugh
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA; (J.L.S.); (L.A.B.)
- Center for Brain and Behavior Research, University of South Dakota, Vermillion, SD 57069, USA;
| | - Patti Berg-Poppe
- Center for Brain and Behavior Research, University of South Dakota, Vermillion, SD 57069, USA;
- Department of Physical Therapy, University of South Dakota, Vermillion, SD 57069, USA
| | - Arun Singh
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA; (J.L.S.); (L.A.B.)
- Center for Brain and Behavior Research, University of South Dakota, Vermillion, SD 57069, USA;
- Correspondence:
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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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Rahimpour S, Gaztanaga W, Yadav AP, Chang SJ, Krucoff MO, Cajigas I, Turner DA, Wang DD. Freezing of Gait in Parkinson's Disease: Invasive and Noninvasive Neuromodulation. Neuromodulation 2021; 24:829-842. [PMID: 33368872 PMCID: PMC8233405 DOI: 10.1111/ner.13347] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Freezing of gait (FoG) is one of the most disabling yet poorly understood symptoms of Parkinson's disease (PD). FoG is an episodic gait pattern characterized by the inability to step that occurs on initiation or turning while walking, particularly with perception of tight surroundings. This phenomenon impairs balance, increases falls, and reduces the quality of life. MATERIALS AND METHODS Clinical-anatomical correlations, electrophysiology, and functional imaging have generated several mechanistic hypotheses, ranging from the most distal (abnormal central pattern generators of the spinal cord) to the most proximal (frontal executive dysfunction). Here, we review the neuroanatomy and pathophysiology of gait initiation in the context of FoG, and we discuss targets of central nervous system neuromodulation and their outcomes so far. The PubMed database was searched using these key words: neuromodulation, freezing of gait, Parkinson's disease, and gait disorders. CONCLUSION Despite these investigations, the pathogenesis of this process remains poorly understood. The evidence presented in this review suggests FoG to be a heterogenous phenomenon without a single unifying pathologic target. Future studies rigorously assessing targets as well as multimodal approaches will be essential to define the next generation of therapeutic treatments.
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Affiliation(s)
- Shervin Rahimpour
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Wendy Gaztanaga
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Amol P. Yadav
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stephano J. Chang
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Max O. Krucoff
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
- Department of Biomedical Engineering, Marquette University & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Iahn Cajigas
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dennis A. Turner
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
- Departments of Neurobiology and Biomedical Engineering, Duke University, Durham, NC, USA
| | - Doris D. Wang
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
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Cerebellar atrophy and its contribution to motor and cognitive performance in multiple system atrophy. NEUROIMAGE-CLINICAL 2019; 23:101891. [PMID: 31226621 PMCID: PMC6587071 DOI: 10.1016/j.nicl.2019.101891] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/26/2019] [Accepted: 06/04/2019] [Indexed: 11/25/2022]
Abstract
Objective Neuroanatomical differences in the cerebellum are among the most consistent findings in multiple system atrophy (MSA) patients. This study performed a detailed cerebellar morphology in MSA patients and its two subtypes: MSA-P (parkinson's symptoms predominate) and MSA-C (cerebellar symptoms predominant), and their relations to profiles of motor and cognitive deficits. Materials and methods Structure MRI data were acquired from 63 healthy controls and 61 MSA patients; voxel-based morphometry and the Spatially Unbiased Infratentorial Toolbox cerebellar atlas were performed to identify the cerebellar gray volume changes in MSA and its subtypes. Further, the gray matter changes were correlated with the clinical motor/cognitive scores. Results Patients with MSA exhibited widespread loss of cerebellar volume bilaterally, relative to healthy controls. In those with MSA-C, gray matter loss was detected from anterior (bilateral lobule IV-V) to posterior (bilateral crus I/II, bilateral lobule IX, left lobule VIII) cerebellar lobes. Lower anterior cerebellar volume negatively correlated with disease duration and motor performance, whereas posterior lobe integrity positively correlated with cognitive assessment. In patients with MSA-P, atrophy of anterior lobe (bilateral lobules IV-V) and posterior lobe in part (left lobule VI, bilateral IX) was evident; and in left cerebellar lobule IX, gray matter loss negatively correlated with motor scores. Direct comparison of MSA-P and MSA-C group outcomes showed divergence in right cerebellar crus II only. Conclusions Our data suggest that volumetric abnormalities of cerebellum contribute substantially to motor and cognitive performance in patients with MSA. In patients with MSA-P and MSA-C, affected regions of cerebellum differed. Cerebellum atrophy contributed substantially to motor and cognitive behavior in MSA. Lower cerebellum IV-V volume was correlated with MSA-C disease duration and severity Cerebellum atrophy in one side may imply symptoms onset on contralateral
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Salsone M, Caligiuri ME, Vescio V, Arabia G, Cherubini A, Nicoletti G, Morelli M, Quattrone A, Vescio B, Nisticò R, Novellino F, Cascini GL, Sabatini U, Montilla M, Rektor I, Quattrone A. Microstructural changes of normal-appearing white matter in Vascular Parkinsonism. Parkinsonism Relat Disord 2019; 63:60-65. [DOI: 10.1016/j.parkreldis.2019.02.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/24/2019] [Accepted: 02/27/2019] [Indexed: 11/25/2022]
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Raccagni C, Nonnekes J, Bloem BR, Peball M, Boehme C, Seppi K, Wenning GK. Gait and postural disorders in parkinsonism: a clinical approach. J Neurol 2019; 267:3169-3176. [PMID: 31119450 PMCID: PMC7578144 DOI: 10.1007/s00415-019-09382-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 02/07/2023]
Abstract
Disturbances of balance, gait and posture are a hallmark of parkinsonian syndromes. Recognition of these axial features can provide important and often early clues to the nature of the underlying disorder, and, therefore, help to disentangle Parkinson’s disease from vascular parkinsonism and various forms of atypical parkinsonism, including multiple system atrophy, progressive supranuclear palsy, and corticobasal syndrome. Careful assessment of axial features is also essential for initiating appropriate treatment strategies and for documenting the outcome of such interventions. In this article, we provide an overview of balance, gait and postural impairment in parkinsonian disorders, focusing on differential diagnostic aspects.
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Affiliation(s)
- Cecilia Raccagni
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Jorik Nonnekes
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Marina Peball
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christian Boehme
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Batla A, De Pablo-Fernandez E, Erro R, Reich M, Calandra-Buonaura G, Barbosa P, Balint B, Ling H, Islam S, Cortelli P, Volkmann J, Quinn N, Holton JL, Warner TT, Bhatia KP. Young-onset multiple system atrophy: Clinical and pathological features. Mov Disord 2018; 33:1099-1107. [DOI: 10.1002/mds.27450] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/19/2018] [Accepted: 04/19/2018] [Indexed: 01/07/2023] Open
Affiliation(s)
- Amit Batla
- University College London (UCL) Institute of Neurology; London UK
| | - Eduardo De Pablo-Fernandez
- Reta Lila Weston Institute of Neurological Studies; UCL Institute of Neurology; London UK
- Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology; London UK
| | - Roberto Erro
- University College London (UCL) Institute of Neurology; London UK
- Center for Neurodegenerative diseases, Department of Medicine, Surgery and Dentistry; University of Salerno; Salerno Italy
| | - Martin Reich
- Department of Neurology; University Clinic of Würzburg; Würzburg Germany
| | - Giovanna Calandra-Buonaura
- Istituti di Ricovero e Cura a Carattere. Scientifico (IRCCS) Institute of Science and Neurology of Bologna; Bologna Italy
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Pedro Barbosa
- Reta Lila Weston Institute of Neurological Studies; UCL Institute of Neurology; London UK
- Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology; London UK
| | - Bettina Balint
- University College London (UCL) Institute of Neurology; London UK
- Department of Neurology; University Hospital Heidelberg; Heidelberg Germany
| | - Helen Ling
- Reta Lila Weston Institute of Neurological Studies; UCL Institute of Neurology; London UK
- Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology; London UK
| | | | - Pietro Cortelli
- Istituti di Ricovero e Cura a Carattere. Scientifico (IRCCS) Institute of Science and Neurology of Bologna; Bologna Italy
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Jens Volkmann
- Department of Neurology; University Clinic of Würzburg; Würzburg Germany
| | - Niall Quinn
- National Hospital for Neurology and Neurosurgery; London UK
| | - Janice L. Holton
- Reta Lila Weston Institute of Neurological Studies; UCL Institute of Neurology; London UK
- Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology; London UK
- Department of Molecular Neuroscience, UCL Institute of Neurology; University College London; London UK
| | - Thomas T. Warner
- Reta Lila Weston Institute of Neurological Studies; UCL Institute of Neurology; London UK
- Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology; London UK
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13
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Locomozione: fisiologia, metodi di analisi e classificazione dei principali disturbi. Neurologia 2017. [DOI: 10.1016/s1634-7072(17)85553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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14
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Early Freezing of Gait: Atypical versus Typical Parkinson Disorders. PARKINSONS DISEASE 2015; 2015:951645. [PMID: 25785228 PMCID: PMC4345077 DOI: 10.1155/2015/951645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/22/2015] [Indexed: 11/17/2022]
Abstract
In 18 months, 850 patients were referred to Muhammad Ali Parkinson Center (MAPC). Among them, 810 patients had typical Parkinson disease (PD) and 212 had PD for ≤5 years. Among the 212 patients with early PD, 27 (12.7%) had freezing of gait (FOG). Forty of the 850 had atypical parkinsonism. Among these 40 patients, all of whom had symptoms for ≤5 years, 12 (30.0%) had FOG. FOG improved with levodopa in 21/27 patients with typical PD but did not improve in the 12 patients with atypical parkinsonism. FOG was associated with falls in both groups of patients. We believe that FOG unresponsive to levodopa in typical PD resembles FOG in atypical parkinsonism. We thus compared the 6 typical PD patients with FOG unresponsive to levodopa plus the 12 patients with atypical parkinsonism with the 21 patients with typical PD responsive to levodopa. We compared them by tests of locomotion and postural stability. Among the patients with FOG unresponsive to levodopa, postural stability was more impaired than locomotion. This finding leads us to believe that, in these patients, postural stability, not locomotion, is the principal problem underlying FOG.
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Herman T, Rosenberg-Katz K, Jacob Y, Auriel E, Gurevich T, Giladi N, Hausdorff JM. White matter hyperintensities in Parkinson's disease: do they explain the disparity between the postural instability gait difficulty and tremor dominant subtypes? PLoS One 2013; 8:e55193. [PMID: 23383104 PMCID: PMC3561367 DOI: 10.1371/journal.pone.0055193] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 12/19/2012] [Indexed: 01/18/2023] Open
Abstract
Background Brain white matter hyperintensities (WMHs) commonly observed on brain imaging of older adults are associated with balance and gait impairment and have also been linked to cognitive deficits. Parkinson’s disease (PD) is traditionally sub-classified into the postural instability gait difficulty (PIGD) sub-type, and the tremor dominant (TD) sub-type. Considering the known association between WMHs and axial symptoms like gait disturbances and postural instability, one can hypothesize that WMHs might contribute to the disparate clinical sub-types of patients with PD. Methods 110 patients with PD underwent a clinical evaluation and a 3T MRI exam. Based on the Unified Parkinson Disease Rating Scale, the patients were classified into motor sub-types, i.e., TD or PIGD, and scores reflecting PIGD and TD symptoms were computed. We compared white matter burden using three previously validated methods: one using a semi-quantitative visual rating scale in specific brain regions and two automated methods. Results Overall, MRI data were obtained in 104 patients. The mean WMHs scores and the percent of subjects with lesions in specific brain regions were similar in the two subtypes, p = 0.678. The PIGD and the TD scores did not differ even when comparing patients with a relatively high burden of WMHs to patients with a relatively low burden. Across most of the brain regions, mild to moderate correlations between WMHs and age were found (r = 0.23 to 0.41; p<0.021). Conversely, no significant correlations were found between WMHs and the PIGD score or disease duration. In addition, depressive symptoms and cerebro-vascular risk factors were similar among the two subtypes. Conclusions In contrast to what has been reported previously among older adults, the present study could not demonstrate any association between WMHs and the PIGD or TD motor sub-types in patients with PD.
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Affiliation(s)
- Talia Herman
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Keren Rosenberg-Katz
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Functional Brain Imaging Unit, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Yael Jacob
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Functional Brain Imaging Unit, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Eitan Auriel
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Tanya Gurevich
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nir Giladi
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jeffrey M. Hausdorff
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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Azulay JP, Cantiniaux S, Vacherot F, Vaugoyeau M, Assaiante C. Locomozione: fisiologia, tecniche di analisi e classificazione dei principali disturbi. Neurologia 2011. [DOI: 10.1016/s1634-7072(11)70696-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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19
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Falls and gait disorders in geriatric neurology. Clin Neurol Neurosurg 2010; 112:265-74. [DOI: 10.1016/j.clineuro.2009.12.015] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 08/17/2009] [Accepted: 12/27/2009] [Indexed: 11/23/2022]
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20
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Azulay JP, Vacherot F, Vaugoyeau M. Locomotion : physiologie et classification des principaux troubles. Rev Neurol (Paris) 2010; 166:142-8. [DOI: 10.1016/j.neurol.2009.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 09/11/2009] [Accepted: 10/28/2009] [Indexed: 11/16/2022]
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21
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Welter ML, Westby G, Chastan N. Les troubles de la marche et de l’équilibre dans les syndromes parkinsoniens « plus ». Rev Neurol (Paris) 2010; 166:188-95. [DOI: 10.1016/j.neurol.2009.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 05/11/2009] [Accepted: 05/25/2009] [Indexed: 10/20/2022]
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22
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Cardiac MIBG scintigraphy in Primary Progressive Freezing Gait. Parkinsonism Relat Disord 2009; 15:365-9. [DOI: 10.1016/j.parkreldis.2008.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 08/21/2008] [Indexed: 12/16/2022]
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23
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Okuma Y, Yanagisawa N. The clinical spectrum of freezing of gait in Parkinson's disease. Mov Disord 2008; 23 Suppl 2:S426-30. [DOI: 10.1002/mds.21934] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
Freezing of Gait (FOG) is one of the most disabling and least understood symptoms in Parkinson's disease (PD), and is usually observed in the advanced stage of the disease. FOG can be experienced on turning, in narrow spaces, whilst reaching a destination, and in stressful situations. FOG is commonly observed in the "off" state, but it can also be observed in the "on" state. Dual tasking (cognitive load) aggravates FOG. Visual or auditory cues often resolve FOG. Analysis of gait revealed that the rhythm of stepping suddenly jumps into high frequency (4-5 Hz) in FOG (hastening), and that floor reaction forces are disregulated. Stride-to-stride variability is increased in FOG. Hastening phenomenon was reported not only in PD patients but also in patients with striatal lesions. The basal ganglia and its frontal projections may be one of the essential lesion sites for FOG.A recent study using single-photon emission tomography (SPECT) revealed enhanced lateral premotor cortex (PMC) activity during paradoxical gait in PD, suggesting that PMC can compensate for the impaired function of the medial frontal cortex when cued by visual input. Treatment of FOG includes behavioural, medical, and surgical approaches. Tricks of all kinds (including external cues) are effective therapeutic approaches. If FOG occurs predominantly in the "off" state, dopaminergic therapy can be increased. For "on" freezing or if "on" response is otherwise optimised, the dose of the dopaminergic agent may be manipulated, but it could lead to the deterioration of parkinsonism. Deep brain stimulation of the STN often alleviates FOG in the "off" state.
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Affiliation(s)
- Yasuyuki Okuma
- Department of Neurology, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan.
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25
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Giladi N, Huber-Mahlin V, Herman T, Hausdorff JM. Freezing of gait in older adults with high level gait disorders: association with impaired executive function. J Neural Transm (Vienna) 2007; 114:1349-53. [PMID: 17576512 DOI: 10.1007/s00702-007-0772-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 05/22/2007] [Indexed: 11/28/2022]
Abstract
Freezing of gait (FOG) is frequently observed in high level gait disorders (HLGD), but its relationship to disease progression and cognitive function is unknown. To study this relationship, episodic gait disturbances, affect and cognitive function were assessed in twenty-five patients with HLGD (mean age: 78.2 +/- 5.0 yrs). After a mean of 32.2 +/- 4.2 months, twenty-two patients were reassessed. FOG was observed in 20% of the patients at baseline and in 40% at follow-up. The presence of FOG was associated with significant mobility disturbances, functional deterioration as well as poor performance on the frontal neuropsychological assessment battery (Dementia Rating Scale - initiation sub-score) at follow-up. Depression, anxiety and fear of falling were not correlated with the presence of FOG at baseline or follow-up. These results indicate that FOG is common in HLGD, and that it is associated with significant functional disability and a specific frontal cognitive disturbance of initiation.
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Affiliation(s)
- N Giladi
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Bloem BR, Hausdorff JM, Visser JE, Giladi N. Falls and freezing of gait in Parkinson's disease: a review of two interconnected, episodic phenomena. Mov Disord 2004; 19:871-84. [PMID: 15300651 DOI: 10.1002/mds.20115] [Citation(s) in RCA: 800] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Falls and freezing of gait are two "episodic" phenomena that are common in Parkinson's disease. Both symptoms are often incapacitating for affected patients, as the associated physical and psychosocial consequences have a great impact on the patients' quality of life, and survival is diminished. Furthermore, the resultant loss of independence and the treatment costs of injuries add substantially to the health care expenditures associated with Parkinson's disease. In this clinically oriented review, we summarise recent insights into falls and freezing of gait and highlight their similarities, differences, and links. Topics covered include the clinical presentation, recent ideas about the underlying pathophysiology, and the possibilities for treatment. A review of the literature and the current state-of-the-art suggests that clinicians should not feel deterred by the complex nature of falls and freezing of gait; a careful clinical approach may lead to an individually tailored treatment, which can offer at least partial relief for many affected patients.
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Affiliation(s)
- Bastiaan R Bloem
- Department of Neurology, University Medical Centre St. Radboud, Nijmegen, The Netherlands.
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