Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel.
Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
J Neurol. 2020 Sep;267(9):2582-2588. doi: 10.1007/s00415-020-09856-7. Epub 2020 May 7.
Evaluating freezing of gait (FOG) and quantifying its severity in patients with Parkinson's disease (PD) is challenging; objective assessment is not sufficiently established. We aimed to improve the ability to objectively evaluate FOG severity by investigating the value of measuring the duration of the test and its components. Seventy-one patients with PD and FOG completed a previously validated FOG-provoking test. The test was performed under three conditions: (1) usual, single task; (2) dual task (walking while carrying a tray); and (3) triple task (walking while holding a tray and subtracting 7 s). FOG and festination were scored using standard procedures. We evaluated effect sizes based on both the original scoring and the test duration for the motor-cognitive cost and before and after anti-Parkinsonian medication intake. Additionally, video recording of the test and total time frozen were measured. As expected, the original test score and the test duration increased across the three conditions of the task and were higher in OFF than in the ON-medication state (p < 0.036). For motor-cognitive cost, higher effect sizes were observed for the test duration of each condition, compared to the original scoring in OFF state (0.85 vs. 0.68, respectively). Change in effect size category was more pronounced in the ON state vs. OFF (0.87 vs. 0.55, respectively). Test duration was the only independent predictor for the self-report of FOG severity and the total time frozen during the test. These findings suggest that quantifying the duration of each condition of the FOG-provoking test improves its sensitivity to medications and task complexity. Timing can be used to provide immediate, objective feedback of freezing severity, and a clear interpretation of a patient's performance.
评估帕金森病（PD）患者的冻结步态（FOG）并量化其严重程度具有挑战性；客观评估尚未充分建立。我们旨在通过研究测量测试及其组成部分的持续时间的价值来提高客观评估 FOG 严重程度的能力。71 名患有 FOG 的 PD 患者完成了先前经过验证的 FOG 诱发测试。该测试在三种情况下进行：（1）通常，单一任务；（2）双重任务（行走时携带托盘）；（3）三重任务（行走时拿着托盘并减去 7 秒）。FOG 和冲动分别采用标准程序进行评分。我们根据原始评分和运动认知成本的测试持续时间以及抗帕金森药物摄入前后评估了效应量。此外，还测量了测试的视频记录和总冻结时间。正如预期的那样，原始测试评分和测试持续时间随着任务的三个条件的增加而增加，并且在关闭状态下高于 ON 药物状态（p <0.036）。对于运动认知成本，与关闭状态下的原始评分相比，每个条件的测试持续时间的效应量更大（分别为 0.85 与 0.68）。与关闭状态相比，ON 状态下的效应量类别变化更为明显（分别为 0.87 与 0.55）。测试持续时间是自我报告的 FOG 严重程度和测试过程中总冻结时间的唯一独立预测因素。这些发现表明，量化 FOG 诱发测试的每个条件的持续时间可以提高其对药物和任务复杂性的敏感性。时间可以用来提供冻结严重程度的即时、客观反馈，并对患者的表现进行清晰的解释。
