Rosenblum Uri, Cocks Adam J, Norris Meriel, Kal Elmar, Young William R
Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, UK.
Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
J Parkinsons Dis. 2025 Jun;15(4):829-842. doi: 10.1177/1877718X251326266. Epub 2025 May 20.
BackgroundAnxiety often exacerbates freezing of gait (FOG) in people with Parkinson's (PwP). Anxiety-related attentional processes and associated processing inefficiencies, like conscious movement processing (CMP) and ruminations, can substantially impact movement control. However, their impact on FOG remains largely unexplored.ObjectiveTo validate an adapted 10-item (1-5 Likert scale) Gait-Specific Attentional Profile (G-SAP) in PwP and assess if adapted G-SAP-subscales (Physiological Arousal, CMP, Rumination, and Processing Inefficiencies) are associated with self-reported FOG frequency.MethodsWe recruited 440 PwP (M = 65.5 ± 8.7; 5.8 ± 5.0 years since diagnosis) across the UK. Participants completed the adapted G-SAP and questionnaires on demographics, medical background, and FOG frequency. We assessed adapted G-SAP's internal consistency, structural validity, and subscale scores associations with FOG frequency.ResultsThe adapted G-SAP showed acceptable internal consistency (α≥0.66) and acceptable/good model fit (comparative fit index = 0.976). Physiological Arousal and CMP subscale scores presented weaker correlations for PwP with FOG (PwP + FOG, r = 0.52) compared to PwP without FOG (PwP-FOG, r = 0.77; p = 0.006). Higher Rumination (OR: 1.323, 95%CI: [1.214-1.440]) and Physiological Arousal (OR: 1.195, 95%CI:[1.037-1.377]) were significantly associated with higher FOG frequency, controlling for age, time since diagnosis and balance/gait problems.ConclusionsThe adapted G-SAP is reliable and convenient to measure and identify potentially maladaptive anxiety-related attentional processes that may impact FOG. Results suggest that PwP who experience more worrisome thoughts and greater physiological arousal in daily life are likelier to freeze. Compared to PwP-FOG, for PwP + FOG high physiological arousal was associated with reduced goal-directed focus of attention. Future research will determine if this is a causal risk factor.
背景
焦虑常常会加剧帕金森病患者（PwP）的冻结步态（FOG）。与焦虑相关的注意力过程以及相关的处理效率低下，如有意识运动处理（CMP）和反复思考，会对运动控制产生重大影响。然而，它们对FOG的影响在很大程度上仍未得到探索。
目的
验证适用于PwP的10项（1 - 5李克特量表）特定步态注意力概况（G - SAP），并评估调整后的G - SAP子量表（生理唤醒、CMP、反复思考和处理效率低下）是否与自我报告的FOG频率相关。
方法
我们在英国招募了440名PwP（M = 65.5 ± 8.7；诊断后5.8 ± 5.0年）。参与者完成了调整后的G - SAP以及关于人口统计学、医学背景和FOG频率的问卷。我们评估了调整后的G - SAP的内部一致性、结构效度以及子量表得分与FOG频率的关联。
结果
调整后的G - SAP显示出可接受的内部一致性（α≥0.66）和可接受/良好的模型拟合（比较拟合指数 = 0.976）。与无FOG的PwP（PwP - FOG，r = 0.77；p = 0.006）相比，有FOG的PwP的生理唤醒和CMP子量表得分的相关性较弱（PwP + FOG，r = 0.52）。在控制年龄、诊断后时间以及平衡/步态问题后，较高的反复思考（OR：1.323，95%CI：[1.214 - 1.440]）和生理唤醒（OR：1.195，95%CI：[1.037 - 1.377]）与较高的FOG频率显著相关。
结论
调整后的G - SAP测量可靠且方便，可识别可能影响FOG的潜在适应不良的焦虑相关注意力过程。结果表明，在日常生活中经历更多令人担忧的想法和更高生理唤醒的PwP更有可能出现冻结。与PwP - FOG相比，对于PwP + FOG，高生理唤醒与目标导向注意力的降低有关。未来的研究将确定这是否是一个因果风险因素。
