Objective: To evaluate the influence of anxiety on attentional allocation when visual cues are provided for Parkinson’s Disease patients with freezing of gait.

Background: It is well recognized that anxiety can exacerbate freezing of gait (FOG) in Parkinson’s Disease (PD). Similarly, there is a well known benefit in utilizing visual cues to overcome FOG by compensating for sensory-perceptual deficits. However, it is unclear whether cueing remains effective when faced with anxiety given that freezers may be less able to utilize visual feedback whilst high levels of anxiety are ‘consuming’ limited attentional resources. In this study utilizing Virtual Reality (VR), we measured gaze behaviour to determine whether anxiety from threat influenced attention to visual cues.

Method: In this study, 13 PD freezers (PD+FOG) (9M, 3F, aged 59-88) were analyzed OFF their regular dopaminergic medications. Patients completed 12 walking trials across a virtual plank located on the ground (low threat) and the same plank, elevated above a deep pit (high threat). On half of the trials (both high and low threat), visual cues were present (horizontal lines on the plank). Anxiety was self-reported after each trial using self-assessment manikins. Dwell time (% of total fixations) and number of fixations on areas of interest (AOIs) were recorded from the HTC VIVE ProEye HMD to examine gaze behaviour changes. Stationary gaze entropy (SGE) was calculated to determine randomness of the gaze pattern.

Results: Patients reported higher anxiety during elevated compared to ground conditions (p<0.001), and less anxiety when cues were present (p=0.063). In the elevated condition, dwell time (p<0.001) and the number of fixations (p<0.001) were higher for gaze focused on the environment beyond the plank, whilst during the ground condition, dwell time on the plank was higher. Additionally, SGE was higher during the elevated compared to ground conditions (p<0.001). There were no significant effects or interactions of visual cueing on any outcomes.

Conclusion: This study found that anxiety influences attentional allocation, regardless of the presence of visual cues. As opposite gaze behaviours were found during threat, anxiety may have drawn attention away from attending to cues, with more random SGE reflecting reduced top-down attentional control. Future work should examine whether modulating anxiety enhances effectivity of visual cueing.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/looking-away-anxiety-interferes-with-the-ability-of-freezers-to-attend-to-visual-cues/