Objective: To comprehensively identify risk factors of freezing of gait (FOG) in Parkinson’s disease (PD), we performed a meta-analysis by combining the results of previous studies. This approach can help us provide lifestyle recommendations and guide clinical practice for improving the management and treatment of Parkinson’s disease.

Background: FOG is a common episodic gait disorder in patients with PD, characterized by a paroxysmal brief inability to initiate or resume walking within several seconds. FOG can lead to falls, fracture and disability, but its pathogenesis is not well understood and current therapeutic approaches have fallen short of expectations. Therefore, investigating risk factors of FOG development is requisite. However, there are still disputes in the field and a comprehensive summary of these risk factors remains sparse.

Method: A systematic search from inception to Jan 2023 was performed to conduct meta-analysis and investigate the association between potential factors and FOG. Observational studies which explored the probable risk factors for FOG in PD were considered ulteriorly. Pooled effect were used to calculate values by a random-effect model.

Results: In the analysis, we identified a total of 21,697 articles, from which we selected 34 studies that met our pre-determined criteria for inclusion. From these studies, we identified 11 factors that were significantly associated with the development of FOG in PD. Specifically, lower limbs as onset site (RR: 1.80), motor fluctuations (RR: 2.06), psychotic symptoms (RR: 3.80), fall and balance problems (RR: 2.28), depressive symptoms (RR: 1.05), longer disease duration (RR: 1.09), higher levodopa equivalent dose (LED (RR: 1.23), higher Hoehn and Yahr (H-Y) stage (RR: 1.98), higher Unified PD Rating Scale (UPDRS) II (RR: 1.22) and III (RR: 1.03) score were all found to be associated with an increased risk of developing FOG in PD. However, tremor dominant phenotype (RR: 0.24) exhibited opposite result.

Conclusion: From this meta-analysis, we have comprehensively identified the risk factors of FOG in patients with PD. This information can help clinicians identify high-risk patients and provide targeted interventions and practical lifestyle recommendations to prevent the development of FOG. Our findings can thus significantly improve the management and treatment of PD and enhance the quality of life for patients with this condition.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/risk-factors-for-freezing-of-gait-in-parkinsons-disease-a-systematic-review-and-meta-analysis/