Gan Yifei, Xie Hutao, Qin Guofan, Wu Delong, Shan Ming, Hu Tianqi, Yin Zixiao, An Qi, Ma Ruoyu, Wang Shu, Zhang Quan, Zhu Guanyu, Zhang Jianguo
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China.
J Clin Med. 2023 Apr 10;12(8):2799. doi: 10.3390/jcm12082799.
Freezing of gait (FOG) is a common disabling symptom in Parkinson's disease (PD). Cognitive impairment may contribute to FOG. Nevertheless, their correlations remain controversial. We aimed to investigate cognitive differences between PD patients with and without FOG (nFOG), explore correlations between FOG severity and cognitive performance and assess cognitive heterogeneity within the FOG patients. Seventy-four PD patients (41 FOG, 33 nFOG) and 32 healthy controls (HCs) were included. Comprehensive neuropsychological assessments testing cognitive domains of global cognition, executive function/attention, working memory, and visuospatial function were performed. Cognitive performance was compared between groups using independent -test and ANCOVA adjusting for age, sex, education, disease duration and motor symptoms. The k-means cluster analysis was used to explore cognitive heterogeneity within the FOG group. Correlation between FOG severity and cognition were analyzed using partial correlations. FOG patients showed significantly poorer performance in global cognition (MoCA, < 0.001), frontal lobe function (FAB, = 0.015), attention and working memory (SDMT, < 0.001) and executive function (SIE, = 0.038) than nFOG patients. The FOG group was divided into two clusters using the cluster analysis, of which cluster 1 exhibited worse cognition, and with older age, lower improvement rate, higher FOGQ3 score, and higher proportion of levodopa-unresponsive FOG than cluster 2. Further, in the FOG group, cognition was significantly correlated with FOG severity in MoCA (r = -0.382, = 0.021), Stroop-C (r = 0.362, = 0.030) and SIE (r = 0.369, = 0.027). This study demonstrated that the cognitive impairments of FOG were mainly reflected by global cognition, frontal lobe function, executive function, attention and working memory. There may be heterogeneity in the cognitive impairment of FOG patients. Additionally, executive function was significantly correlated with FOG severity.
冻结步态（FOG）是帕金森病（PD）中一种常见的致残症状。认知障碍可能导致FOG。然而，它们之间的相关性仍存在争议。我们旨在研究有和没有FOG的PD患者（nFOG）之间的认知差异，探讨FOG严重程度与认知表现之间的相关性，并评估FOG患者内部的认知异质性。纳入了74例PD患者（41例有FOG，33例无FOG）和32例健康对照者（HCs）。进行了全面的神经心理学评估，测试了整体认知、执行功能/注意力、工作记忆和视觉空间功能等认知领域。使用独立样本t检验和协方差分析（ANCOVA）对年龄、性别、教育程度、病程和运动症状进行校正后，比较了各组之间的认知表现。采用k均值聚类分析来探索FOG组内的认知异质性。使用偏相关分析FOG严重程度与认知之间的相关性。与nFOG患者相比，FOG患者在整体认知（蒙特利尔认知评估量表，<0.001）、额叶功能（额叶评估量表，=0.015）、注意力和工作记忆（符号数字模式测验，<0.001）以及执行功能（斯特鲁普干扰效应，=0.038）方面表现明显更差。通过聚类分析将FOG组分为两个亚组，其中亚组1的认知更差，年龄更大，改善率更低，FOG问卷第3项得分更高，左旋多巴无反应性FOG的比例比亚组2更高。此外，在FOG组中，蒙特利尔认知评估量表（r=-0.382，=0.021）、斯特鲁普C（r=0.362，=0.030）和斯特鲁普干扰效应（r=0.369，=0.027）的认知与FOG严重程度显著相关。这项研究表明，FOG的认知障碍主要体现在整体认知、额叶功能、执行功能、注意力和工作记忆方面。FOG患者的认知障碍可能存在异质性。此外，执行功能与FOG严重程度显著相关。
