Amboni M, Stocchi F, Abbruzzese G, Morgante L, Onofrj M, Ruggieri S, Tinazzi M, Zappia M, Attar M, Colombo D, Simoni L, Ori A, Barone P, Antonini A
IDC Hermitage-Capodimonte - Napoli, Italy; Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
Department of Neurology, Institute of Research and Medical Care, IRCCS San Raffaele, Rome, Italy.
Parkinsonism Relat Disord. 2015 Jun;21(6):644-9. doi: 10.1016/j.parkreldis.2015.03.028. Epub 2015 Apr 13.
Freezing of Gait (FOG) is a common and disabling symptom in patients with Parkinson disease (PD). The relationship between FOG and dopaminergic medication is complex. The aim of the present study was to estimate the prevalence of self-reported FOG, its associated clinical features, and its relationship with wearing-off in a wide PD population. This is an observational multicenter study of 634 consecutive non-demented PD patients. Patients were identified either as freezers or non-freezers based on item-3 of the Freezing of Gait-Questionnaire. FOG was then classified as on, off and onoff freezing based on its relationship with wearing-off. Patients were assessed with Unified Parkinson's Disease Rating Scale, Hoehn and Yahr scale, 8-item Parkinson's disease Questionnaire, Mini-Mental State Examination. Data from 593 patients were analyzed, 325 (54.3%) were freezers of whom 200 (61.6%) experienced FOG only during off state (off-freezers), 6 (1.8%) only during on state and 119 (36.6%) either in on and off states or independently of dopaminergic response-related symptoms (onoff-freezers). Overall, freezers vs non-freezers had longer disease duration, more advanced disease and greater disability. Moreover, freezers more frequently reported wearing-off and experienced worse quality of life. Onoff-freezers vs off-freezers were older, more severely disabled, less likely to experience wearing-off, treated with lower levodopa equivalent daily dose and with poorer cognitive performance. Self-reported FOG is mainly recognizable in advanced PD and is associated with more disability and worse quality of life. Onoff-FOG may represent the result of under-treatment or rather interpretable as a distinct clinical entity.
冻结步态（FOG）是帕金森病（PD）患者常见的致残症状。FOG与多巴胺能药物之间的关系很复杂。本研究的目的是评估在广泛的PD患者群体中自我报告的FOG的患病率、其相关临床特征及其与剂末现象的关系。这是一项对634例连续的非痴呆PD患者进行的观察性多中心研究。根据冻结步态问卷的第3项将患者分为冻结者或非冻结者。然后根据FOG与剂末现象的关系将其分类为开期、关期和开关期冻结。使用统一帕金森病评定量表、Hoehn和Yahr量表、8项帕金森病问卷、简易精神状态检查表对患者进行评估。对593例患者的数据进行了分析，其中325例（54.3%）为冻结者，其中200例（61.6%）仅在关期出现FOG（关期冻结者），6例（1.8%）仅在开期出现，119例（36.6%）在开期和关期均出现或与多巴胺能反应相关症状无关（开关期冻结者）。总体而言，冻结者与非冻结者相比，病程更长、病情更严重且残疾程度更高。此外，冻结者更频繁地报告剂末现象，生活质量更差。开关期冻结者与关期冻结者相比，年龄更大、残疾更严重、出现剂末现象的可能性更小，左旋多巴等效日剂量更低，认知表现更差。自我报告的FOG主要在晚期PD中可识别，并且与更多残疾和更差的生活质量相关。开关期FOG可能代表治疗不足的结果，或者更可解释为一种独特的临床实体。
