Clinical features of Parkinson's disease with freezing of gait

Abstract

Objective To explore the clinical features of freezing of gait (FOG) in Parkinson's disease (PD) patients. Methods Two hundred and sixty-five PD patients from the Department of Neurology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine were consecutively recruited between March 2012 and August 2014. According to the complaints of FOG and the gait symptoms, PD patients were further divided into two groups: PD with FOG group (n=70) and PD without FOG group (n=195). Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr (H-Y) stage were used to evaluate the severity of the motor symptoms. The Non-Motor Symptoms Questionnaire (NMSQuest) was initially used to investigate the occurrence of non-motor symptoms, and odor discrimination was performed with the 16-item odor identification test from extended version of Sniffin' Sticks (SS-16). Simultaneously, all participants were evaluated with rapid eye movement sleep behavior disorder screening questionnaire (RBDSQ) for detecting RBD in PD patients and autonomic dysfunction was assessed with the Scale for Outcomes in PD-Autonomic (SCOPA-AUT). The Mini-Mental State Examination (MMSE) and the 17-item Hamilton Depression Rating Scale (HAMD-17) were also used to evaluate the cognitive function and severity of depressive symptoms, respectively. Results (1) 26.42% (70/265) of PD patients had been experiencing FOG.(2) The duration of the disease (8.00 (5.00, 10.00) years vs 4.00 (2.00, 6.00) years, Z=–6.797, P<0.001) or the age ((65.23±7.79) years vs (61.76±8.39) years, t= 3.018, P=0.003) in PD with FOG group was significantly longer or older than that in non-FOG group.(3) Most of the motor symptoms in FOG group, including H-Y stage (2.50 (2.38, 3.00) vs 1.50 (1.00, 2.50), Z=–7.264, P<0.001), UPDRS-Ⅱscore (14.13±4.59 vs 9.51±3.77, t=7.552, P<0.001), UPDRS-Ⅲ score (27.00 (18.75, 37.25) vs 20.00 (15.00, 26.00), Z=–4.228, P<0.001) and the levodopa equivalent dose (LED; 637.50 (425.00, 800.78) mg vs 262.50 (100.00, 450.00) mg, Z=–7.630, P<0.001) showed significantly higher values than that in non-FOG group.(4) The non-motor symptoms (NMSQuest: 6.50 (5.00, 9.25) vs 5.00 (3.00, 7.00), Z=–3.748, P<0.001) occurred much frequently in FOG group, especially in the depression (HAMD-17: 6.50 (3.00, 10.00) vs 4.00 (1.00, 7.00), Z=–3.739, P<0.001) and autonomic dysfunctions (SCOPA-AUT: 13.39±6.48 vs 9.79±6.17, t= 4.129, P<0.001), but there were no significant differences between the two groups in cognitive function, RBD and odor discrimination.(5) The binary Logistic regression analysis indicated that FOG correlated with H-Y stage (B=1.333, P<0.001), LED (B=0.002, P=0.003) and HAMD-17 score (B=0.127, P=0.041). Conclusions FOG is a common symptom in PD patients. It is mainly related to depression, disease progression and levodopa treatment. Motor dysfunctions and non-motor symptoms were more popular in PD patients with FOG. Key words: Parkinson disease; Gait; Gait disorders, neurologic