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Original Investigation |

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

Santiago Perez-Lloret, MD, PhD1,2,3; Laurence Negre-Pages, PhD4; Philippe Damier, MD, PhD5,6; Arnaud Delval, MD, PhD7; Pascal Derkinderen, MD, PhD5,6; Alain Destée, MD6,7,8; Wassilios G. Meissner, MD, PhD9,10,11; Ludwig Schelosky, MD12; Francois Tison, MD, PhD6,9,10,11; Olivier Rascol, MD, PhD1,2,3,6
[+] Author Affiliations
1Department of Clinical Pharmacology, Faculty of Medicine, University Hospital, University of Toulouse, Toulouse, France
2Department of Neurosciences, University Hospital, University of Toulouse, Toulouse, France
3Clinical Investigation Center 1436, University Hospital Toulouse, Institut National de la Santé et de la Recherche Médicale (INSERM), Toulouse, France
4LN Pharma, Toulouse, France
5Department of Neurology, Hôpital Laënnec, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France
6NS-Park Network, INSERM, Toulouse, France
7Department of Neurology, CHU Lille, Lille, France
8INSERM U 837 Eq6, Lille, France
9Institut des Maladies Neurodégénératives, Université de Bordeaux, Bordeaux, France
10Centre National de la Recherche Scientifique, Institut des Maladies Neurodégénératives, Bordeaux, France
11Service de Neurologie, CHU de Bordeaux, Bordeaux, France
12Neurology Department, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
JAMA Neurol. 2014;71(7):884-890. doi:10.1001/jamaneurol.2014.753.
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Importance  Freezing of gait (FOG) is a common axial symptom of Parkinson disease (PD).

Objective  To determine the prevalence of FOG in a large group of PD patients, assess its relationship with quality of life and clinical and pharmacological factors, and explore its changes from the off to on conditions in patients with motor fluctuations.

Design, Setting, and Participants  Cross-sectional survey of 683 patients with idiopathic PD. Scores for FOG were missing in 11 patients who were not included in the analysis. Patients were recruited from referral centers and general neurology clinics in public or private institutions in France.

Exposure  Patients with FOG were identified as those with a score of 1 or greater on item 14 of the Unified Parkinson’s Disease Rating Scale (UPDRS) in the on condition. Item 14 scores for FOG in the off condition were also collected in patients with fluctuating motor symptoms.

Main Outcomes and Measures  Quality of life (measured by the 39-item Parkinson’s Disease Questionnaire and 36-Item Short Form Health Survey), anxiety and depression (Hospital Anxiety and Depression Scale), clinical features (UPDRS), and drug consumption.

Results  Of 672 PD patients, 257 reported FOG during the onstate (38.2%), which was significantly related to lower quality of life scores (P < .01). Freezing of gait was also correlated with longer PD duration (odds ratio, 1.92 [95% CI, 1.28-2.86]), higher UPDRS parts II and III scores (4.67 [3.21-6.78]), the presence of apathy (UPDRS item 4) (1.94 [1.33-2.82]), a higher levodopa equivalent daily dose (1.63 [1.09-2.43]), and more frequent exposure to antimuscarinics (3.07 [1.35-6.97]) (logistic regression). The FOG score improved from the off to on states in 148 of 174 patients with motor fluctuations (85.1%) and showed no change in 13.8%. The FOG score improved by more than 50% in 43.7% of patients. Greater improvement in the on state was observed in younger patients (r = −0.25; P < .01) with lower UPDRS II and III scores (r = −0.50; P < .01) and no antimuscarinic use (r = −0.21; P < .01).

Conclusions and Relevance  Freezing of gait in PD patients correlates with poor quality of life, disease severity, apathy, and exposure to antimuscarinics. Dopaminergic therapy improved FOG in most patients with motor fluctuations, especially younger ones with less severe disease and no antimuscarinic use. This finding suggests that quality of life is impaired in PD patients with FOG and that optimizing dopaminergic therapy and avoiding antimuscarinics should be considered.

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Figure 1.
Frequency of Freezing of Gait (FOG) by Hoehn and Yahr Scale Stages in the On State

A significant linear trend across stages was disclosed by results of a χ2 test (P < .001). No patient had a stage 5.0 rating.

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Figure 2.
Quality-of-Life Scores in Patients With or Without Freezing of Gait (FOG) in the On State

A, Scores on the 39-item Parkinson’s Disease Questionnaire (PDQ-39). B, Scores on the 36-Item Short Form Health Survey (SF-36). Higher PDQ-39 scores and lower SF-36 scores reflect worse quality of life. Error bars indicate SEM.aP < .01, 2-sided t test with step-down Holms correction for multiple comparisons.

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Figure 3.
Relationship Between Freezing of Gait (FOG) Severity and Quality of Life

Quality of life was measured by the 39-item Parkinson’s Disease Questionnaire (PDQ-39) total score and the 36-Item Short Form Health Survey (SF-36) Physical and Mental Component scores according to FOG severity. Error bars indicate SEM. The FOG scores are described in the FOG Evaluation subsection of the Methods section.aP < .05 compared with patients without FOG (Dunnet post hoc test after an analysis of variance test21).

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