Relationships between Freezing of Gait Severity and Cognitive Deficits in Parkinson’s Disease

Jamie L Scholl,Matt Leedom,Patti Berg-Poppe,Wijdan Rai,Lee A Baugh,Arun Singh,Arturo I Espinoza

doi:10.3390/brainsci11111496

Jamie L Scholl, Matt Leedom + Show 5 more

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https://doi.org/10.3390/brainsci11111496

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Abstract

Freezing of gait (FOG) is one of the most debilitating motor symptoms experienced by patients with Parkinson’s disease (PD), as it can lead to falls and a reduced quality of life. Evidence supports an association between FOG severity and cognitive functioning; however, results remain debatable. PD patients with (PDFOG+, n = 41) and without FOG (PDFOG–, n = 39) and control healthy subjects (n = 41) participated in this study. The NIH toolbox cognition battery, the Montreal Cognitive Assessment (MoCA), and the interval timing task were used to test cognitive domains. Measurements were compared between groups using multivariable models and adjusting for covariates. Correlation analyses, linear regression, and mediation models were applied to examine relationships among disease duration and severity, FOG severity, and cognitive functioning. Significant differences were observed between controls and PD patients for all cognitive domains. PDFOG+ and PDFOG– exhibited differences in Dimensional Change Card Sort (DCCS) test, interval timing task, and MoCA scores. After adjusting for covariates in two different models, PDFOG+ and PDFOG– differed in both MoCA and DCCS scores. In addition, significant relationships between FOG severity and cognitive function (MoCA, DCCS, and interval timing) were also found. Regression models suggest that FOG severity may be a predictor of cognitive impairment, and mediation models show the effects of cognitive impairment on the relationship between disease severity and FOG severity. Overall, this study provides insight into the relationship between cognitive and FOG severity in patients with PD, which could aid in the development of therapeutic interventions to manage both.

Highlights

Freezing of gait (FOG) has attracted attention within clinical and scientific groups, as it is one of the most mismanaged motor symptoms in Parkinson’s disease (PD) [1,2].Approximately 80% of patients with advanced-stage PD develop FOG, increasing risk of falls, loss of independence, reduced quality of life, and the expression of mood disorders [3].FOG occurs in ~26% of patients in early-stage PD [4]; not all patients withPD go on to develop FOG symptoms, regardless of disease severity or duration
When comparing PDFOG+ and PDFOG, there were no differences in disease duration; differences were found in motor disease severity, medication, and sleep scores (Table 1)
FOG represents a significant problem for patients with PD

Summary

Introduction

Freezing of gait (FOG) has attracted attention within clinical and scientific groups, as it is one of the most mismanaged motor symptoms in Parkinson’s disease (PD) [1,2].Approximately 80% of patients with advanced-stage PD develop FOG, increasing risk of falls, loss of independence, reduced quality of life, and the expression of mood disorders [3].FOG occurs in ~26% of patients in early-stage PD [4]; not all patients withPD go on to develop FOG symptoms, regardless of disease severity or duration. Freezing of gait (FOG) has attracted attention within clinical and scientific groups, as it is one of the most mismanaged motor symptoms in Parkinson’s disease (PD) [1,2]. 80% of patients with advanced-stage PD develop FOG, increasing risk of falls, loss of independence, reduced quality of life, and the expression of mood disorders [3]. PD go on to develop FOG symptoms, regardless of disease severity or duration. This variability suggests that different factors, such as age, depression, anxiety, and sleeping problems, or physiological abnormalities, such as increased beta-band oscillations in the cortico-basal ganglia network, may be involved in the development of FOG in patients with PD [5,6]. FOG in PD population increases with the disease duration [11]

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