Gait Freezing in Parkinson Disease

Prevalence, Determinants, and Effect on Quality of Life of Freezing of Gait in Parkinson Disease

Perez-Lloret S, Negre-Pages L, Damier P, et al
JAMA Neurol. 2014 May 19. [Epub ahead of print]

Study Summary

Parkinson disease is often associated with freezing of gait (FOG), which is an unpredictable, transient break in walking, occurring when starting to walk or during gait and particularly when turning. This cross-sectional survey aimed to examine the prevalence of FOG in a large group patients with Parkinson disease recruited from referral centers and general neurology clinics in public or private institutions in France. Additional goals were to determine the association of FOG with quality of life and clinical and pharmacologic characteristics, and to evaluate changes from the off to on conditions among patients experiencing motor fluctuations.

Of 683 patients with idiopathic Parkinson disease who were surveyed, 11 had missing FOG scores and were therefore not included in the analysis. FOG was defined as a score of at least 1 on item 14 of the Unified Parkinson's Disease Rating Scale (UPDRS) in the on condition.

During the on state, 257 of 672 patients (38.2%) had FOG. This was associated with lower quality-of-life scores on the 39-item Parkinson's Disease Questionnaire and 36-Item Short Form Health Survey (P < .01). Other clinical correlates of FOG were longer Parkinson disease duration (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.28-2.86), higher UPDRS parts II and III scores (OR, 4.67; 95% CI, 3.21-6.78), and apathy (UPDRS item 4; OR,1.94; 95% CI, 1.33-2.82).

Pharmacologic correlates of FOG were a higher levodopa equivalent daily dose (OR, 1.63; 95% CI,1.09-2.43) and more frequent exposure to antimuscarinic agents (OR, 3.07; 95% CI,1.35-6.97 on logistic regression). Most patients with motor fluctuations (148 of 174; 85.1%) had improvements in FOG score from the off to on states, whereas 13.8% had no change. In 43.7% of patients, the FOG score improved by more than 50%.

Factors associated with greater improvement in FOG score in the on state were younger age (r = -0.25; P < .01), lower UPDRS parts II and III scores (r = -0.50; P < .01), and no antimuscarinic use (r = -0.21; P < .01).

Viewpoint

Limitations of this study include cross-sectional design precluding determination of changes in FOG over time, reliance on self-report, and possible lack of generalizability, as patients with dementia were excluded. Nonetheless, the findings of this study, which is the largest study of FOG in patients with Parkinson disease to date, suggest that FOG correlates with poor quality of life, disease severity, apathy, and exposure to antimuscarinics. Poor quality of life linked with FOG may reflect loss of control, mobility restriction, exposure to falling risk, and therefore loss of overall mobility and independence.

Most patients with motor fluctuations, especially younger patients with less severe disease and no antimuscarinic use, had improvement of FOG in response to dopaminergic therapy. Poor quality of life in patients with FOG prompts consideration of optimizing dopaminergic therapy and avoiding antimuscarinic drugs.

Abstract

Cite this: Laurie L. Barclay. Gait Freezing in Parkinson Disease - Medscape - Jun 05, 2014.

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