Prevalence, determinants, and effect on quality of life of freezing of gait in Parkinson disease.
OBJECTIVE
Freezing of gait (FOG) is a common axial symptom of Parkinson disease (PD).


OBJECTIVE
To determine the prevalence of FOG in a large group of PD patients, assess its relationship with quality of life and clinical and pharmacological factors, and explore its changes from the off to on conditions in patients with motor fluctuations.


METHODS
Cross-sectional survey of 683 patients with idiopathic PD. Scores for FOG were missing in 11 patients who were not included in the analysis. Patients were recruited from referral centers and general neurology clinics in public or private institutions in France.


METHODS
Patients with FOG were identified as those with a score of 1 or greater on item 14 of the Unified Parkinson's Disease Rating Scale (UPDRS) in the on condition. Item 14 scores for FOG in the off condition were also collected in patients with fluctuating motor symptoms.


METHODS
Quality of life (measured by the 39-item Parkinson's Disease Questionnaire and 36-Item Short Form Health Survey), anxiety and depression (Hospital Anxiety and Depression Scale), clinical features (UPDRS), and drug consumption.


RESULTS
Of 672 PD patients, 257 reported FOG during the onstate (38.2%), which was significantly related to lower quality of life scores (P < .01). Freezing of gait was also correlated with longer PD duration (odds ratio, 1.92 [95% CI, 1.28-2.86]), higher UPDRS parts II and III scores (4.67 [3.21-6.78]), the presence of apathy (UPDRS item 4) (1.94 [1.33-2.82]), a higher levodopa equivalent daily dose (1.63 [1.09-2.43]), and more frequent exposure to antimuscarinics (3.07 [1.35-6.97]) (logistic regression). The FOG score improved from the off to on states in 148 of 174 patients with motor fluctuations (85.1%) and showed no change in 13.8%. The FOG score improved by more than 50% in 43.7% of patients. Greater improvement in the on state was observed in younger patients (r = -0.25; P < .01) with lower UPDRS II and III scores (r = -0.50; P < .01) and no antimuscarinic use (r = -0.21; P < .01).


CONCLUSIONS
Freezing of gait in PD patients correlates with poor quality of life, disease severity, apathy, and exposure to antimuscarinics. Dopaminergic therapy improved FOG in most patients with motor fluctuations, especially younger ones with less severe disease and no antimuscarinic use. This finding suggests that quality of life is impaired in PD patients with FOG and that optimizing dopaminergic therapy and avoiding antimuscarinics should be considered.
Department of Clinical Pharmacology, Faculty of Medicine, University Hospital, University of Toulouse, Toulouse, France2Department of Neurosciences, University Hospital, University of Toulouse, Toulouse, France3Clinical Investigation Center 1436, Universi.
Santiago
S
Perez-Lloret
LN Pharma, Toulouse, France.
Laurence
L
Negre-Pages
Department of Neurology, Hôpital Laënnec, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France6NS-Park Network, INSERM, Toulouse, France.
Philippe
P
Damier
Department of Neurology, CHU Lille, Lille, France.
Arnaud
A
Delval
Department of Neurology, Hôpital Laënnec, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France6NS-Park Network, INSERM, Toulouse, France.
Pascal
P
Derkinderen
NS-Park Network, INSERM, Toulouse, France7Department of Neurology, CHU Lille, Lille, France8INSERM U 837 Eq6, Lille, France.
Alain
A
Destée
Institut des Maladies Neurodégénératives, Université de Bordeaux, Bordeaux, France10Centre National de la Recherche Scientifique, Institut des Maladies Neurodégénératives, Bordeaux, France11Service de Neurologie, CHU de Bordeaux, Bordeaux, France.
Wassilios G
WG
Meissner
Neurology Department, Kantonsspital Münsterlingen, Münsterlingen, Switzerland.
Ludwig
L
Schelosky
NS-Park Network, INSERM, Toulouse, France9Institut des Maladies Neurodégénératives, Université de Bordeaux, Bordeaux, France10Centre National de la Recherche Scientifique, Institut des Maladies Neurodégénératives, Bordeaux, France11Service de Neurologie.
Francois
F
Tison
Department of Clinical Pharmacology, Faculty of Medicine, University Hospital, University of Toulouse, Toulouse, France2Department of Neurosciences, University Hospital, University of Toulouse, Toulouse, France3Clinical Investigation Center 1436, Universi.
Olivier
O
Rascol
D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D005260:Female; D005602:France / Q000453:epidemiology; D005684:Gait / Q000502:physiology*; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage; D008297:Male; D018727:Muscarinic Antagonists / Q000008:administration & dosage; D010300:Parkinson Disease / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D013997:Time Factors
D000978:Antiparkinson Agents; D018727:Muscarinic Antagonists; D007980:Levodopa