Freezing of gait in Parkinson's disease: Prevalence, determinants and impact on quality of life

SANTIAGO PEREZ LLORET; OLIVIER RASCOL

Congreso; 18th International Congress of Parkinson's Disease and Movement Disorders; 2014

Objective: To determine the prevalence, assess the impact on Quality of Life (QoL) and describe clinicalTo determine the prevalence, assess the impact on Quality of Life (QoL) and describe clinicaland pharmacological factors related to Freezing of Gait (FoG) in a large group of Parkinson's Disease (PD)patients. To assess the change in FoG scores from OFF to ON in patients with motor fluctuations.patients. To assess the change in FoG scores from OFF to ON in patients with motor fluctuations.Background: FoG is a frequent feature in PD related to disease severity, cognitive impairment, and motorcomplications.FoG is a frequent feature in PD related to disease severity, cognitive impairment, and motorcomplications.Methods: 683 PD patients of the COPARK survey were evaluated. Eleven patients had missing data, sofinal sample was 672. Patients with FoG were identified as those with a UPDRS Item 14 ¡Ý1 in the ONcondition. In patients with motor fluctuations, FoG was also evaluated in the OFF condition by means of thesame question. All patients were assessed in a standardized manner: demographics, treatments, UnifiedPD Rating Scale (UPDRS), Hospital Anxiety and Depression Scale and QoL scales (SF36, PDQ39).683 PD patients of the COPARK survey were evaluated. Eleven patients had missing data, sofinal sample was 672. Patients with FoG were identified as those with a UPDRS Item 14 ¡Ý1 in the ONcondition. In patients with motor fluctuations, FoG was also evaluated in the OFF condition by means of thesame question. All patients were assessed in a standardized manner: demographics, treatments, UnifiedPD Rating Scale (UPDRS), Hospital Anxiety and Depression Scale and QoL scales (SF36, PDQ39).¡Ý1 in the ONcondition. In patients with motor fluctuations, FoG was also evaluated in the OFF condition by means of thesame question. All patients were assessed in a standardized manner: demographics, treatments, UnifiedPD Rating Scale (UPDRS), Hospital Anxiety and Depression Scale and QoL scales (SF36, PDQ39).Results: FoG was reported by 257/672 PD patients during the ON-state (38%). A multivariate logisticregression showed that FoG was significantly related to increased PDQ39 total score (OR, 95% CI: 1.32,1.04-1.67), reduced SF-36 physical (0.68, 0.54-0.87) or mental scores (0.71, 0.57-0.88) after adjustingfor disease severity, duration and motor complication. FoG severity was directly related to increased PDQ-39 or decreased SF-36 scores. Logistic regression showed that FoG was also independently related withlonger PD duration (1.92, 1.28-2.86), higher UPDRS II+III score (4.67, 3.21-6.78), the presence of apathyassessed by UPDRS item 4 (1.94, 1.33-2.82), higher levodopa equivalent daily dose (1.63, 1.09-2.43) andmore frequent exposure to antimuscarinics (3.07, 1.35-6.97). FoG improved from OFF to ON in 148/174(86%) patients with motor fluctuations (>50% improvement in 44%), while there was no change in 15% .Improvement from OFF to ON correlated significantly with older age (r=-0.25), UPDRS II+III score (r=-0.496), depression score (r=-0.17), Apathy score (r=-0.20), OFF-ON H&Y difference (r=-0.17), exposureto ancholinergics (r=-0.21), exposure to dopamine agonists (r=0.18) or entacapone (r=0.21).FoG was reported by 257/672 PD patients during the ON-state (38%). A multivariate logisticregression showed that FoG was significantly related to increased PDQ39 total score (OR, 95% CI: 1.32,1.04-1.67), reduced SF-36 physical (0.68, 0.54-0.87) or mental scores (0.71, 0.57-0.88) after adjustingfor disease severity, duration and motor complication. FoG severity was directly related to increased PDQ-39 or decreased SF-36 scores. Logistic regression showed that FoG was also independently related withlonger PD duration (1.92, 1.28-2.86), higher UPDRS II+III score (4.67, 3.21-6.78), the presence of apathyassessed by UPDRS item 4 (1.94, 1.33-2.82), higher levodopa equivalent daily dose (1.63, 1.09-2.43) andmore frequent exposure to antimuscarinics (3.07, 1.35-6.97). FoG improved from OFF to ON in 148/174(86%) patients with motor fluctuations (>50% improvement in 44%), while there was no change in 15% .Improvement from OFF to ON correlated significantly with older age (r=-0.25), UPDRS II+III score (r=-0.496), depression score (r=-0.17), Apathy score (r=-0.20), OFF-ON H&Y difference (r=-0.17), exposureto ancholinergics (r=-0.21), exposure to dopamine agonists (r=0.18) or entacapone (r=0.21).Conclusions: FoG was related to worse quality of life in PD patients and correlated with PD severity,cognitive deficit and antimuscarinics exposure. Dopaminergic therapy improved FoG in most patients withmotor fluctuations, especially in younger ones, with less severe disease and no antimuscarinics.FoG was related to worse quality of life in PD patients and correlated with PD severity,cognitive deficit and antimuscarinics exposure. Dopaminergic therapy improved FoG in most patients withmotor fluctuations, especially in younger ones, with less severe disease and no antimuscarinics.