Objective: To clarify risk factors for, and clinical associations of, freezing of gait (FOG) in Parkinson’s disease (PD).

Background: FOG is a disabling and incompletely understood phenomenon in PD.

Method: 164 subjects with PD were assessed cross-sectionally with the MDS-UPDRS scale, modified Hoehn and Yahr (HY) Stage, MMSE and Clinical Dementia Rating scale. MDS-UPDRS subscores were used to define/rate PIGD, tremor-predominant and indeterminate phenotypes, FOG, the Balance-Gait (PIGD minus FOG) score, non-motor symptoms (nM-EDL) and motor complications (MC). Univariate tests followed by nominal logistic regression (Log Regr) were used to determine clinical predictors and associations of FOG.

Results: FOG affected 64 (39%) subjects, and was associated with HY stage (≥3, p<0.0001), 57 (89%) having PIGD. FOG+ subjects were more likely to have MC and a higher levodopa equivalent dose (LED) (p<0.0001). Compared with PIGD/FOG- subjects, PIGD/FOG+ subjects had a longer PD duration, higher Bal-Gait score, higher LED, more frequent dyskinesias, a higher motor fluctuation impact score and total off score, more frequent psychosis and urinary problems and a higher total nM-EDL score, but similar cognitive status. Similarly, relative to MC/FOG- subjects, MC/FOG+ subjects were older with a longer PD duration, had a higher LED, higher bradykinesia and Bal-Gait scores, more frequent psychosis, urinary problems and orthostatic dizziness, and had a higher nM-EDL score, but similar cognition. Compared to PIGD/MC- subjects, PIGD/MC+ subjects were more likely to have FOG and anxiety. PIGD score predicted dementia (p<0.0001). Both dementia and cognitive impairment (Cog Imp)(nM-EDL) were associated with increased likelihood of FOG in MC- subjects, 48% of whom had PIGD, but not in MC+ subjects, 77% of whom had PIGD. By Log Regr, PIGD (p<0.0001), together with either MC and Cog Imp (p=0.006 and p = 0.003 respectively) or LED and Cog Imp (p=0.0002 and p=0.01 respectively) predicted FOG (p<0.0001).

Conclusion: In PD: (1) PIGD, MC/LED and Cog Imp are unique risk factors for FOG and may be additive in their effects; (2) FOG subjects have more severe motor dysfunction, especially Bal-Gait disorder; (3) FOG is associated with increased burden of nM symptoms, especially urinary problems, orthostatic dizziness and psychosis; (4) Further studies should clarify the mechanisms by which PIGD, MC and Cog Imp, separately and interactively, may predispose to FOG.

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/freezing-of-gait-in-parkinsons-disease-risk-factors-and-associated-nonmotor-symptoms/