Wu Li, Wang Qin, Zhao Lei, Jiang Chun-Yan, Xu Qian, Wu Si-Cheng, Dong You-Rong, He Qing, Chen Wei, Liu Jian-Ren
Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Neurology, Zhongshan Hospital Fudan University, Shanghai, China.
Front Aging Neurosci. 2020 Jul 31;12:237. doi: 10.3389/fnagi.2020.00237. eCollection 2020.
Accumulating evidence suggests that freezing of gait (FOG) is a unique gait disturbance in Parkinson's disease (PD), and its pathophysiology is not fully elucidated. The present study aims to investigate the clinical and oculomotor associations with FOG in Chinese PD patients. From Jan 2017 to Dec 2019, a total of 210 PD patients were consecutively registered for FOG evaluation based on item-3 of the Freezing of Gait Questionnaire (FOGQ). We explored the demographic, motor, and non-motor symptom differences in FOG positive (PD+FOG, = 45) vs. negative (PD-FOG, = 165) group. In addition, 40 PD patients and 37 healthy controls (HC) also underwent oculomotor test via videonystagmography (VNG). Visually guided saccade (VGS) latency, saccade accuracy and gain in smooth pursuit eye movement (SPEM) at three frequencies of horizontal axis were compared among PD+FOG ( = 20), PD-FOG ( = 20), and HC ( = 37). Compared with PD-FOG, PD+FOG had longer disease duration, more severe motor symptoms, lower cognitive scores, more severe depressive and autonomic impairments, as well as higher daily levodopa equivalent dosage. FOG occurred more frequently in patients with wearing-off. VNG subgroup analysis demonstrated that PD+FOG had prolonged saccade latency and decreased saccade accuracy relative to PD-FOG or HC. SPEM gain at 0.1 and 0.2 Hz was also decreased in PD+FOG compared with HC. Furthermore, prolonged saccade latency was correlated with higher FOGQ scores in PD patients. Our results verify that PD with FOG patients suffer from more severe motor and non-motor symptoms, indicating more extensive neurodegeneration. Prolonged saccade latency could be a practical oculomotor parameter both for identification and progression of FOG in PD.
越来越多的证据表明,冻结步态(FOG)是帕金森病(PD)中一种独特的步态障碍,其病理生理学尚未完全阐明。本研究旨在调查中国PD患者中与FOG相关的临床和动眼神经关联。2017年1月至2019年12月,共有210例PD患者基于步态冻结问卷(FOGQ)的第3项被连续登记进行FOG评估。我们探讨了FOG阳性(PD+FOG,n = 45)与阴性(PD-FOG,n = 165)组在人口统计学、运动和非运动症状方面的差异。此外,40例PD患者和37名健康对照(HC)也通过视频眼震图(VNG)进行了动眼神经测试。比较了PD+FOG(n = 20)、PD-FOG(n = 20)和HC(n = 37)在水平轴三个频率下视觉引导扫视(VGS)潜伏期、扫视准确性和平滑跟踪眼动(SPEM)增益。与PD-FOG相比,PD+FOG病程更长,运动症状更严重,认知评分更低,抑郁和自主神经功能障碍更严重,每日左旋多巴等效剂量更高。FOG在症状波动的患者中更频繁出现。VNG亚组分析表明,与PD-FOG或HC相比,PD+FOG的扫视潜伏期延长,扫视准确性降低。与HC相比,PD+FOG在0.1和0.2 Hz时的SPEM增益也降低。此外,PD患者中延长的扫视潜伏期与更高的FOGQ评分相关。我们的结果证实,伴有FOG的PD患者存在更严重的运动和非运动症状,表明神经退行性变更广泛。延长的扫视潜伏期可能是PD中FOG识别和进展的一个实用动眼神经参数。