Relationship between Freezing of Gait and Anxiety in Parkinson's Disease Patients: A Systemic Literature Review.

Ivan Witt,Penny MacDonald,Hooman Ganjavi

doi:10.1155/2019/6836082

Abstract

Freezing of gait (FOG) is experienced by a significant number of patients with Parkinson's disease (PD). The pathophysiology of this disabling motor symptom remains unclear, and there are no effective therapies. Anxiety has previously been posited as a contributing factor to gait freezing. There have been few studies directly investigating this topic, and a comprehensive literature review is lacking. The objective of this paper was to systematically review the evidence associating anxiety with the presence, severity, and progression of FOG in PD patients. The PubMed, EMBASE, and PsycINFO databases were searched up to September 19, 2018, for English-language, peer-reviewed articles that explored anxiety and FOG as outcome measures in a PD population base. Review articles, case reports, and articles that assessed gait disorders other than FOG were excluded, yielding a total of 26 articles in the final analysis. Of these 26 studies, 16 had a significant relationship between anxiety outcome measure and either presence or severity of FOG. There was great variability among studies in terms of outcome measures for both FOG and anxiety. Despite this heterogeneity, most studies relate anxiety and FOG. Standardized, high-validity outcome measures of anxiety and FOG are needed. Future exploration should aim to clarify the role of anxiety in FOG as a causal factor, pathophysiological marker, and manifestation of a common pathophysiological process versus a consequence of FOG itself. Clarifying the relationship between anxiety and FOG could reveal anxiety reduction as a therapy for FOG.

Highlights

Parkinson’s disease (PD) is a neurological movement disorder characterized by four cardinal motor symptoms: bradykinesia, rigidity, resting tremor, and postural instability [1]
Freezing of gait (FOG) is a debilitating motor symptom experienced by 50–80% of PD patients [6, 7]. e third item on the Freezing of Gait (FOG) Questionnaire reads as follows: “Do you feel that your feet get glued to the floor while walking, making a turn, or trying to initiate walking?” [8]. is item functions as a reliable screening tool for the presence of FOG
Our analysis examines research from 11 countries with a combined total of 3,963 PD patients

Summary

Introduction

Parkinson’s disease (PD) is a neurological movement disorder characterized by four cardinal motor symptoms: bradykinesia, rigidity, resting tremor, and postural instability [1]. It is a progressive disease with no cure and no current disease-modifying therapies [2], and 60–80% of dopamine-producing neurons in the substantia nigra pars compacta degenerate over the course of the disease, leading to substantial dopamine reduction in the dorsal striatum and the aforementioned motor symptomatology [3]. Freezing of gait (FOG) is a debilitating motor symptom experienced by 50–80% of PD patients [6, 7]. A small but growing body of research indicates several variables likely contribute to this phenomenon, including PD motor phenotype, cognitive load, emotional stimuli, and environmental factors [9]

Methods

Results

Conclusion