Cognitive function in people with and without freezing of gait in Parkinson\u2019s disease

Rosie Morris,Patricia Carlson-Kuhta,John G Nutt,Martina Mancini,Fay B Horak,Daniel S Peterson,Katrijn Smulders

doi:10.1038/s41531-020-0111-7

Abstract

Freezing of gait (FOG) is common in people with Parkinson’s disease (PD) which is extremely debilitating. One hypothesis for the cause of FOG episodes is impaired cognitive control, however, this is still in debate in the literature. We aimed to assess a comprehensive range of cognitive tests in older adults and people with Parkinson’s with and without FOG and associate FOG severity with cognitive performance. A total of 227 participants took part in the study which included 80 healthy older adults, 81 people with PD who did not have FOG and 66 people with PD and FOG. A comprehensive battery of neuropsychological assessments tested cognitive domains of global cognition, executive function/attention, working memory, and visuospatial function. The severity of FOG was assessed using the new FOG questionnaire and an objective FOG severity score. Cognitive performance was compared between groups using an ANCOVA adjusting for age, gender, years of education and disease severity. Correlations between cognitive performance and FOG severity were analyzed using partial correlations. Cognitive differences were observed between older adults and PD for domains of global cognition, executive function/attention, and working memory. Between those with and without FOG, there were differences for global cognition and executive function/attention, but these differences disappeared when adjusting for covariates. There were no associations between FOG severity and cognitive performance. This study identified no significant difference in cognition between those with and without FOG when adjusting for covariates, particularly disease severity. This may demonstrate that complex rehabilitation programs may be undertaken in those with FOG.

Highlights

Freezing of gait (FOG) is one of the most problematic motor symptoms in Parkinson’s disease (PD) affecting over 60% of patients with a disease duration of 10 years or more[1].FOG contributes to an increased risk of falls, reduced quality of life, increased mood disorders and increased caregiver burden[2,3,4]
A total of 227 participants were recruited to the study; 147 of which were diagnosed with idiopathic PD and 80 healthy older adults (OA)
AControlling for age, gender and years of education. bControlling for age, gender, years of education and MDS-UPDRS III. Those with poorer global cognition had greater freezing severity, but this did not reach the stringent significance level adjusted for multiple comparisons (Fig. 3). This large study compared a comprehensive range of neuropsychological assessments in older adults and people with Parkinson’s disease, with and without freezing of gait

Summary

Introduction

Freezing of gait (FOG) is one of the most problematic motor symptoms in Parkinson’s disease (PD) affecting over 60% of patients with a disease duration of 10 years or more[1].FOG contributes to an increased risk of falls, reduced quality of life, increased mood disorders and increased caregiver burden[2,3,4]. Incidence increases with disease duration but clinically it is difficult to predict which patients will transition to develop FOG. A number of factors contribute to FOG risk which include age, anxiety, depression, and severity of motor symptoms but the role of cognition in the development of FOG is still debated in the literature[5,6,7,8]. The severity of FOG is assessed in the majority of cases using self-report questionnaires dependent on patient subjective recall[15,16]. Previously developed an objective outcome measure of FOG that provides a continuous ratio score validated against both the New FOG self-reported questionnaire and expert neurologist evaluation[17,18]

Objectives

Results

Conclusion