Objective: To compare clinical features of patients with Freezing of gait (FOG+) and without FOG (FOG-), and explore probable predictors of early onset freezing.

Background: FOG is a motor phenomenon observed in patients with Parkinson’s disease (PD). The pathogenesis and natural course of FOG in PD has not been fully understood. 

Methods: A retrospective chart review of 100 patients with PD (FOG+:50,FOG-:50) was performed at the Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India. FOG+ patients were subdivided by a median split of time from motor onset to development of FOG (median:6yrs) into early onset FOG [EOFOG(n=24)] and late onset FOG [LOFOG(n=26)].

Results: The mean age at onset (AAO) of PD was 50.24±8.22yrs in FOG+ and 56.71±7.60yrs in FOG-. Latency from the onset of motor symptoms to the development of FOG was 6.47±3.97 yrs. In both groups, men outnumbered women (FOG+:men 70%, FOG-:men 74%). FOG+ patients were older than FOG- patients (58.58±7.75yrs,54.18±8.23yrs,p<0.01) and had longer duration of symptoms (8.16±9.86yrs,3.90±3.22yrs,p<0.01). Off-state freezing was reported in 88%, with freezing occurring on a daily basis in 88%. The mean Freezing of Gait Questionnaire score was 11.88±1.85. Prevalence of several non-motor symptoms (NMS) were higher in the FOG+ compared to the FOG- patients; these included constipation (56%vs24%,p<0.01), psychosis (50%vs10%,p<0.01), weight loss (46%vs10%,p<0.01) fatigue (48%vs16%,p<0.01) and drooling (36%vs2%,p<0.01). Freezers more frequently reported dyskinesia (64%vs10%,p<0.01) and wearing off (84%vs24%,p<0.01). UPDRS-III off-state scores were significantly higher in freezers (44.59±13.97,30.51±12.09,p<0.01). 
Comparison of demographic and clinical characteristics did not reveal any significant differences between EOFOG and LOFOG groups. Correlation analysis was performed between the AAO of motor symptoms and the latency of onset of FOG. There was a significant negative correlation between the AAO of motor symptoms and the latency of FOG, suggesting a later age at onset of motor symptoms to be a predictor of FOG during the course of PD (r -0.392,p<0.01). 

Conclusions: Significant differences exist between FOG+ and FOG-, especially a higher burden of non-motor symptoms in the former group. Older age at onset of motor symptoms of PD may be a predictor of early onset of FOG during the course of illness. 

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MDS Abstracts - https://www.mdsabstracts.org/abstract/freezing-of-gait-in-parkinsons-disease-clinical-features-and-possible-predictors/