Neuroscience Research Australia, UNSW, Sydney, Australia.
Department of Applied Health Sciences, University of Applied Sciences, Bochum, Germany.
J Parkinsons Dis. 2020;10(2):631-640. doi: 10.3233/JPD-191813.
Freezing of gait (FOG) is a common symptom of Parkinson's disease (PD) which can result in falls and fall related injuries, poor quality of life and reduced functional independence. It is a heterogeneous phenomenon that is difficult to quantify and eludes a unified pathophysiological framework.
Our aim was to document the occurrence and nature of freezing, cognitive stops and stumbles in people with PD during walks with varying cognitive loads and conditions designed to elicit FOG.
130 people with PD walked under four conditions (normal walking, walking plus easy and hard dual-tasks, and a FOG elicitation condition. Video and accelerometry recordings were examined to document freezes and other gait disruptions.
Participants experienced 391 freezes, 97 cognitive stops and 73 stumbles in the trial walks; with total gait disruptions increasing with task complexity. Most freezes in the FOG elicitation condition occurred during turning and approach destination. People who experienced freezing during the walks were more likely to have Postural Instability and Gait Difficulty (PIGD) subtype, longer disease duration and more severe UPDRS part II and part III sub-scores than people who did not freeze. They also took higher doses of levodopa, reported freezing in the past month, more prior falls, had poorer executive function, poorer proprioception, slower reaction time, poorer standing and leaning balance, more depressive symptoms, lower quality of life and greater fear of falling. PD disease duration, reduced controlled leaning balance and poor proprioception were identified as independent and significant determinants of freezing in logistic regression analysis.
The multiple motor and cognitive factors identified as being associated with freezing, including poor proprioception and impaired controlled leaning balance provide new insights into this debilitating PD symptom and may contribute to potential new targets for rehabilitation.
冻结步态（FOG）是帕金森病（PD）的常见症状，可导致跌倒和跌倒相关损伤、生活质量下降和功能独立性降低。它是一种异质性现象，难以量化，也没有统一的病理生理框架。
我们的目的是记录 PD 患者在不同认知负荷和设计诱发 FOG 的条件下行走时冻结、认知停顿和踉跄的发生和性质。
130 名 PD 患者在 4 种条件下行走（正常行走、行走加简单和困难双重任务，以及 FOG 诱发条件）。视频和加速度计记录用于记录冻结和其他步态障碍。
参与者在试验行走中经历了 391 次冻结、97 次认知停顿和 73 次踉跄；随着任务复杂性的增加，总步态障碍增加。FOG 诱发条件下的大多数冻结发生在转弯和接近目的地时。在行走中经历冻结的人更有可能患有姿势不稳和步态困难（PIGD）亚型，疾病持续时间更长，UPDRS 第二部分和第三部分子评分更严重，比没有冻结的人更严重。他们还服用更高剂量的左旋多巴，报告过去一个月有冻结，更多的既往跌倒，执行功能更差，本体感觉更差，反应时间更慢，站立和倾斜平衡更差，抑郁症状更多，生活质量更差，对跌倒的恐惧更大。在逻辑回归分析中，PD 疾病持续时间、降低的控制倾斜平衡和较差的本体感觉被确定为冻结的独立和重要决定因素。
与冻结相关的多种运动和认知因素，包括较差的本体感觉和受损的控制倾斜平衡，为这一使人衰弱的 PD 症状提供了新的见解，并可能为康复提供新的潜在目标。
