Clinical features of freezing of gait in Parkinson's disease patients

Sawada, Makoto; Wada‐Isoe, Kenji; Hanajima, Ritsuko; Nakashima, Kenichiro

doi:10.1002/brb3.1244

Cited by 40 publications

(26 citation statements)

References 36 publications

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“…As anticipated, advanced PD patients could have more severe motor performance and higher H&Y scales. Depression is considered to be related to FOG in PD patients (37). Our results consistently showed that the PD+FOG group had mild depression on average, while the PD-FOG group had a relatively normal GDS scores.…”

Section: Discussionsupporting

confidence: 74%

Transverse Strips Instead of Wearable Laser Lights Alleviate the Sequence Effect Toward a Destination in Parkinson's Disease Patients With Freezing of Gait

et al. 2020

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Background: The sequence effect (SE), referring to step-to-step reduction in amplitude, is considered to lead to freezing of gait (FOG) in Parkinson's disease (PD). Visual cues may alleviate SE and help reduce freezing episodes. FOG patients show significant SE prior to turning or toward a doorway, but the SE toward a destination has not been clearly studied. Objectives: To examine the SE when approaching a destination in PD patients with FOG, and to further explore the effects of different types of visual cues on destination SE. Methods: Thirty-five PD patients were divided into a freezing (PD+FOG, n = 15) group and a non-freezing (PD-FOG, n = 20) group. Walking trials were tested under three conditions, including without cues (no-cue condition), with wearable laser lights (laser condition), and with transverse strips placed on the floor (strip condition). Kinematic data was recorded by a portable Inertial Measurement Unit (IMU) system. The destination SE and some key gait parameters were evaluated. Results: The PD+FOG group showed greater destination SE in the no-cue and laser conditions when compared to the PD-FOG group. There were no significant differences in the strip condition when comparing destination SE of the two groups. The destination SE was alleviated only by using the transverse strips on the floor. In contrast, transverse strips and wearable laser lights could increase the step length. Conclusions: The significant destination SE may explain why FOG patients are prone to freezing when heading toward their destination. Visual cues using transverse strips on the floor may be a more effective strategy for FOG rehabilitation in PD patients.

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Section: Discussionsupporting

confidence: 74%

Transverse Strips Instead of Wearable Laser Lights Alleviate the Sequence Effect Toward a Destination in Parkinson's Disease Patients With Freezing of Gait

et al. 2020

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“…We found FOG in PD to be unrelated to sex and only weakly associated with patient age, consistent with the majority of other prospective studies [ 4 , 8 , 10 – 12 , 30 ]. On the other hand, supporting extensive literature, we found disease duration to be strongly associated with FOG [ 4 – 7 , 9 , 12 , 13 , 31 ]. One previous prospective study failed to show an association between disease duration and incident FOG [ 8 ].…”

Section: Discussionsupporting

confidence: 90%

Freezing of Gait in Parkinson’s Disease: Risk Factors, Their Interactions, and Associated Nonmotor Symptoms

Lichter

Benedict

Hershey

2021

Parkinson's Disease

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Background. Freezing of gait (FOG) is a debilitating and incompletely understood symptom in Parkinson’s disease (PD). Objective. To determine the principal clinical factors predisposing to FOG in PD, their interactions, and associated nonmotor symptoms. Methods. 164 PD subjects were assessed in a cross-sectional retrospective study, using the MDS-UPDRS scale, MMSE, and Clinical Dementia Rating Scale. Clinical factors associated with FOG were determined using univariate analysis and nominal logistic regression. Receiver operating characteristic curves were computed, to obtain measures of sensitivity and specificity of predictors of FOG. Subgroups of patients with FOG were compared with those without FOG, based on defining aspects of their clinical phenotype. Results. Relative to non-FOG patients, those with FOG had a longer disease duration, higher PIGD and balance-gait score, higher LED, and more motor complications ( p < 0.0001 ) and were more likely to exhibit urinary dysfunction ( p < 0.0003 ), cognitive impairment, hallucinations, and psychosis ( p = 0.003 ). The balance-gait score and motor complications, at their optimum cutoff values, together predicted FOG with 86% accuracy. Interactions were noted between cognitive dysfunction and both the Bal-Gait score and motor complication status, cognitive impairment or dementia increasing the likelihood of FOG in subjects without motor complications ( p = 0.0009 ), but not in those with motor complications. Conclusions. Both disease and treatment-related factors, notably LED, influence the risk of FOG in PD, with a selective influence of cognitive dysfunction in patients with balance-gait disorder but not in those with motor fluctuations. These findings may help to inform clinical management and highlight distinct subgroups of patients with PD-FOG, which are likely to differ in their network pathophysiology.

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“…One difference relates to the commencement of FOG where Gilat defined FOG starting when the foot no longer takes an effective step, whereas we took the last heel strike of the last full step as the FOG commencement point as it is easier to precisely identify. A further strength is the use of the gold standard method of video recordings with ancillary reference to synchronised accelerometry data to classify freezing episodes [19,45]. Thus, given the assessments included cognitive and motor factors known to induce FOG episodes, the incidence and nature of the freezes and other gait disturbances observed should generalise well to those experienced in everyday life.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Freezing of Gait in People with Parkinson’s Disease: Nature, Occurrence, and Risk Factors

Lord

Bindels

Ketheeswaran

et al. 2020

JPD

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Background Freezing of gait (FOG) is a common symptom of Parkinson's disease (PD) which can result in falls and fall related injuries, poor quality of life and reduced functional independence. It is a heterogeneous phenomenon that is difficult to quantify and eludes a unified pathophysiological framework. Objective Our aim was to document the occurrence and nature of freezing, cognitive stops and stumbles in people with Parkinson's disease (PD) during walks with varying cognitive loads and conditions designed to elicit freezing-of-gait (FOG). Methods 130 people with PD walked under four conditions (normal walking, walking plus easy and hard dual-tasks, and a FOG elicitation condition. Video and accelerometry recordings were examined to document freezes and other gait disruptions. Results Participants experienced 391 freezes, 97 cognitive stops and 73 stumbles in the trial walks; with total gait disruptions increasing with task complexity. Most freezes in the FOG elicitation condition occurred during turning and approach destination. People who experienced freezing during the walks were more likely to have Postural Instability and Gait Difficulty (PIGD) subtype, longer disease duration and more severe UPDRS part II and part III sub-scores than people who did not freeze. They also took higher doses of levodopa, reported freezing in the past month, more prior falls, had poorer executive function, poorer proprioception, slower reaction time, poorer standing and leaning balance, more depressive symptoms, lower quality of life and greater fear of falling. PD disease duration, reduced controlled leaning balance and poor proprioception were identified as independent and significant determinants of freezing in logistic regression analysis. Conclusion The multiple motor and cognitive factors identified as being associated with freezing, including poor proprioception and impaired controlled leaning balance provide new insights into this debilitating PD symptom and may contribute to potential new targets for rehabilitation.

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Clinical features of freezing of gait in Parkinson's disease patients

Cited by 40 publications

References 36 publications

Transverse Strips Instead of Wearable Laser Lights Alleviate the Sequence Effect Toward a Destination in Parkinson's Disease Patients With Freezing of Gait

Transverse Strips Instead of Wearable Laser Lights Alleviate the Sequence Effect Toward a Destination in Parkinson's Disease Patients With Freezing of Gait

Freezing of Gait in Parkinson’s Disease: Risk Factors, Their Interactions, and Associated Nonmotor Symptoms

Freezing of Gait in People with Parkinson’s Disease: Nature, Occurrence, and Risk Factors

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