Objective: To evaluate the relationship between frontal-subcortical cognitive dysfunctions and freezing of gait (FOG) in Parkinson’s disease (PD).

Background: FOG is a complex and multisystem dysfunction and its pathophysiology remains unclear. FOG has been related to frontal-subcortical impairments (1). In this study we assessed the feasibility of the Parkinson’s disease Cognitive Rating scale (PD-CRS) frontal-subcortical score to detect FOG dysfunctions in PD.

Methods: 43 patients with PD were evaluated with neuropsychological tests and FOG questionnaires. Neuropsychological assessments included: Mini-mental state examination (MMSE), the Montreal cognitive assessment (MOCA) and PD-CRS. Evaluation of FOG was carried out using the Freezing of gait questionnaire (FOGQ). PD-CRS allows distinguishing two patterns of cognitive impairment: frontal-subcortical pattern (item 1, immediate free-recall verbal memory; item 3, sustained attention; item 4, working memory; item 5, clock drawing; item 7, delayed free-recall verbal memory; item 8, alternating verbal fluency; item 9, action verbal fluency) and the instrumental-cortical pattern (item 2, confrontation naming; item 6, copy drawing of a clock).

Results: All cognitive tests were inversely correlated with the FOGQ: MMSE and FOGQ (R=-0,394, p=0,009); MOCA and FOGQ (R=-0,316, p=0,039); PD-CRS and FOGQ (R=-0,400, p=0,008). We significant correlations between PD-CRS frontal-subcortical score and FOGQ (R=-0,424, p=0,005) and we did not find correlation between cortical dysfunction (PD-CRS instrumental-cortical scores) and FOGQ (R=-0,176, p=0,260).

Conclusions: This study again confirm the relationship between FOG and cognition in PD. We found that disturbances in cognitive processes such as attention, executive function and working memory (frontal-subcortical pattern) are associated with FOG . However, posterior cortical alterations such as confrontation naming and copy of a clock (instrumental-cortical pattern) are not linked with FOG. These results could suggest that the PD-CRS frontal-subcortical score could be used as a clinical marker for early diagnosis of freezing of gait disturbances in PD patients.

References: 1. Amboni M, Barone P, Hausdorff JM. Cognitive contributions to gait and falls: evidence and implications. Mov Disord. 2013 Sep 15;28(11):1520-33. doi: 10.1002/mds.25674.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/frontal-subcortical-cognitive-impairments-in-parkinsons-patients-with-freezing-of-gait/