Objective: To develop predictive algorithms for freezing of gait (FOG) in Parkinson’s disease (PD) using longitudinal objective assessment of turning behaviors.

Background: Freezing of Gait (FOG) is often a late-stage motor complication in Parkinson’s disease (PD) that leads to falls and development of fear of falling. It is unclear why FOG manifests at different disease stages in different patients and methods to predict its development would help define populations of patients that could be amenable to early interventions. As FOG occurs most commonly during gait initiation and turning, in this study we longitudinally monitored spatiotemporal parameters of 180-degree pivot turns over an 18-month period to determine which aspects of turning were differentially affected in PD FOG patients.

Method: PD patients with FOG (FOG) or without FOG (no-FOG), and healthy age matched controls (HC) with a Montreal Cognitive Assessment (MoCA) score > 10 and <1 fall per day were included in the study. Every 6 months, subjects made 180-degree pivot turns on visual cues while walking back and forth along the length of a 20’x4’ pressure sensor mat (Protokinetics), in their levodopa ON state. Enrolled subjects who had completed 18 months of follow up were included in the analysis. The slope of change/year (delta) was calculated for turn metrics. Data was analyzed in SPSS 24 (IBM).

Results: 27 subjects were included in the analysis (9 HC, 9 no-FOG and 9 FOG). At enrolment, age (p=0.611) and MoCA scores (p=0.502) were similar between groups. PD subjects had similar disease duration (p=0.058), motor (p=0.184) and total UPDRS (p=0.249) scores, and total daily equivalent levodopa dosage (p=0.109). Compared to no-FOG, FOG subjects had progressive increase in delta mean stance time (p=0.009), stride time (p=0.031) and turning width (p=0.019), which after post-hoc Bonferroni correction for multiple comparisons remained significant for mean delta stance time (FOG 6.4±10.7, no-FOG -2.6±8.7 %change/year, p=0.028).

Conclusion: FOG subjects spend progressively longer time in the stance phase during turning compared to no-FOG. Thus, differential changes in objectively quantifiable parameters of turning may be utilized to create algorithms to predict the development of FOG.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/longitudinal-progression-of-spatiotemporal-parameters-of-turning-in-idiopathic-parkinsons-disease-patients-with-freezing-of-gait/