Advertisement

Journal of Neurology

, Volume 262, Issue 1, pp 108–115 | Cite as

The major impact of freezing of gait on quality of life in Parkinson’s disease

  • Courtney C. Walton
  • James M. Shine
  • Julie M. Hall
  • Claire O’Callaghan
  • Loren Mowszowski
  • Moran Gilat
  • Jennifer Y. Y. Szeto
  • Sharon L. Naismith
  • Simon J. G. Lewis
Original Communication

Abstract

Freezing of gait (FOG) is a disabling motor symptom experienced by a large proportion of patients with Parkinson’s disease (PD). While it is known that FOG contributes to lower health-related quality of life (HRQoL), previous studies have not accounted for other important factors when measuring the specific impact of this symptom. The aim of this study was to examine FOG and HRQoL while controlling for other factors that are known to impact patient well-being, including cognition, motor severity, sleep disturbance and mood. Two hundred and three patients with idiopathic PD (86 with FOG) were included in the study. All patients were between Hoehn and Yahr stages I–III. A forced entry multiple regression model evaluating the relative contribution of all symptoms was conducted, controlling for time since diagnosis and current dopaminergic treatment. Entering all significantly correlated variables into the regression model accounted for the majority of variance exploring HRQoL. Self-reported sleep–wake disturbances, depressive and anxious symptoms and FOG were individually significant predictors. FOG accounted for the highest amount of unique variance. While sleep–wake disturbance and mood have a significant negative impact on HRQoL in PD, the emergence of FOG represents the most substantial predictor among patients in the earlier clinical stages of disease. This finding presumably reflects the disabling loss of independence and fear of injury associated with FOG and underlines the importance of efforts to reduce this common symptom.

Keywords

Parkinson’s disease Freezing of gait Quality of life Depression Anxiety Sleep 

Notes

Acknowledgments

We would like to thank the patients of the Parkinson’s Disease Research Clinic for being so generous with their time and efforts. CC Walton is supported by an Australian Postgraduate Award at the University of Sydney. C O’Callaghan is supported by an Alzheimer’s Australia PhD Scholarship at the University of New South Wales. M Gilat is supported by an International Postgraduate Research Scholarship at the University of Sydney. SL Naismith is supported by an NHMRC Career Development Award No. 1008117. SJG Lewis is supported by an NHMRC Practitioner Fellowship No. 1003007. JM Shine, JM Hall, L Mowszowski and JYY Szeto have no financial disclosures.

Conflicts of interest

The authors declare no conflict of interest.

Ethical standard

This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

References

  1. 1.
    Jankovic J (2008) Parkinson’s disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry 79(4):368–376. doi: 10.1136/jnnp.2007.131045 CrossRefPubMedGoogle Scholar
  2. 2.
    Martinez-Martin P (1998) An introduction to the concept of “quality of life in Parkinson’s disease”. J Neurol 245(Suppl 1):S2–S6CrossRefPubMedGoogle Scholar
  3. 3.
    Peto V, Jenkinson C, Fitzpatrick R, Greenhall R (1995) The development and validation of a short measure of functioning and well being for individuals with Parkinson’s disease. Qual Life Res Int J Qual Life Asp Treat Care Rehabil 4(3):241–248CrossRefGoogle Scholar
  4. 4.
    Muslimovic D, Post B, Speelman JD, Schmand B, de Haan RJ, Group CS (2008) Determinants of disability and quality of life in mild to moderate Parkinson disease. Neurology 70(23):2241–2247. doi: 10.1212/01.wnl.0000313835.33830.80 CrossRefPubMedGoogle Scholar
  5. 5.
    Chapuis S, Ouchchane L, Metz O, Gerbaud L, Durif F (2005) Impact of the motor complications of Parkinson’s disease on the quality of life. Mov Disord Off J Mov Disord Soc 20(2):224–230. doi: 10.1002/mds.20279 CrossRefGoogle Scholar
  6. 6.
    Slawek J, Derejko M, Lass P (2005) Factors affecting the quality of life of patients with idiopathic Parkinson’s disease—a cross-sectional study in an outpatient clinic attendees. Parkinsonism Relat Disord 11(7):465–468. doi: 10.1016/j.parkreldis.2005.04.006 CrossRefPubMedGoogle Scholar
  7. 7.
    Martinez-Martin P, Rodriguez-Blazquez C, Kurtis MM, Chaudhuri KR, Group NV (2011) The impact of non-motor symptoms on health-related quality of life of patients with Parkinson’s disease. Mov Disord Off J Mov Disord Soc 26(3):399–406. doi: 10.1002/mds.23462 CrossRefGoogle Scholar
  8. 8.
    Santos-Garcia D, de la Fuente-Fernandez R (2013) Impact of non-motor symptoms on health-related and perceived quality of life in Parkinson’s disease. J Neurol Sci 332(1–2):136–140. doi: 10.1016/j.jns.2013.07.005 CrossRefPubMedGoogle Scholar
  9. 9.
    Naismith SL, Hickie IB, Lewis SJ (2010) The role of mild depression in sleep disturbance and quality of life in Parkinson’s disease. J Neuropsychiatry Clin Neurosci 22(4):384–389. doi: 10.1176/appi.neuropsych.22.4.384 CrossRefPubMedGoogle Scholar
  10. 10.
    Chaudhuri KR, Healy DG, Schapira AH, National Institute for Clinical E (2006) Non-motor symptoms of Parkinson’s disease: diagnosis and management. Lancet Neurol 5(3):235–245. doi: 10.1016/S1474-4422(06)70373-8 CrossRefPubMedGoogle Scholar
  11. 11.
    Nutt JG, Bloem BR, Giladi N, Hallett M, Horak FB, Nieuwboer A (2011) Freezing of gait: moving forward on a mysterious clinical phenomenon. Lancet Neurol 10(8):734–744. doi: 10.1016/S1474-4422(11)70143-0 CrossRefPubMedGoogle Scholar
  12. 12.
    Kerr GK, Worringham CJ, Cole MH, Lacherez PF, Wood JM, Silburn PA (2010) Predictors of future falls in Parkinson disease. Neurology 75(2):116–124. doi: 10.1212/WNL.0b013e3181e7b688 CrossRefPubMedGoogle Scholar
  13. 13.
    Walton CC, Shine JM, Mowszowski L, Naismith SL, Lewis SJG (2014) Freezing of gait in Parkinson’s disease: current treatments and the potential role for cognitive training. Restor Neurol Neurosci 32(3):411–422. doi: 10.3233/RNN-130370 PubMedGoogle Scholar
  14. 14.
    Heremans E, Nieuwboer A, Vercruysse S (2013) Freezing of gait in Parkinson’s disease: where are we now? Curr Neurol Neurosci Rep 13(6):350. doi: 10.1007/s11910-013-0350-7 CrossRefPubMedGoogle Scholar
  15. 15.
    Perez-Lloret S, Negre-Pages L, Damier P, Delval A, Derkinderen P, Destee A, Meissner WG, Schelosky L, Tison F, Rascol O (2014) Prevalence, determinants, and effect on quality of life of freezing of gait in Parkinson disease. JAMA Neurol. doi: 10.1001/jamaneurol.2014.753 PubMedGoogle Scholar
  16. 16.
    Rahman S, Griffin HJ, Quinn NP, Jahanshahi M (2008) Quality of life in Parkinson’s disease: the relative importance of the symptoms. Mov Disord Off J Mov Disord Soc 23(10):1428–1434. doi: 10.1002/mds.21667 CrossRefGoogle Scholar
  17. 17.
    Moore O, Peretz C, Giladi N (2007) Freezing of gait affects quality of life of peoples with Parkinson’s disease beyond its relationships with mobility and gait. Mov Disord Off J Mov Disord Soc 22(15):2192–2195. doi: 10.1002/mds.21659 CrossRefGoogle Scholar
  18. 18.
    Shine JM, Naismith SL, Lewis SJG (2013) The differential yet concurrent contributions of motor, cognitive and affective disturbance to freezing of gait in Parkinson’s disease. Clin Neurol Neurosurg 115(5):542–545. doi: 10.1016/j.clineuro.2012.06.027 CrossRefPubMedGoogle Scholar
  19. 19.
    Lieberman A (2006) Are freezing of gait (FOG) and panic related? J Neurol Sci 248(1–2):219–222. doi: 10.1016/j.jns.2006.05.023 CrossRefPubMedGoogle Scholar
  20. 20.
    Videnovic A, Marlin C, Alibiglou L, Planetta PJ, Vaillancourt DE, Mackinnon CD (2013) Increased REM sleep without atonia in Parkinson disease with freezing of gait. Neurology 81(12):1030–1035. doi: 10.1212/WNL.0b013e3182a4a408 PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55(3):181–184PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Emre M, Aarsland D, Brown R, Burn DJ, Duyckaerts C, Mizuno Y, Broe GA, Cummings J, Dickson DW, Gauthier S, Goldman J, Goetz C, Korczyn A, Lees A, Levy R, Litvan I, McKeith I, Olanow W, Poewe W, Quinn N, Sampaio C, Tolosa E, Dubois B (2007) Clinical diagnostic criteria for dementia associated with Parkinson’s disease. Mov Disord Off J Mov Disord Soc 22(12):1689–1707. doi: 10.1002/mds.21507 (quiz 1837)CrossRefGoogle Scholar
  23. 23.
    Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17(5):427–442CrossRefPubMedGoogle Scholar
  24. 24.
    Giladi N, Shabtai H, Simon ES, Biran S, Tal J, Korczyn AD (2000) Construction of freezing of gait questionnaire for patients with Parkinsonism. Parkinsonism Relat Disord 6(3):165–170CrossRefPubMedGoogle Scholar
  25. 25.
    Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stern MB, Dodel R, Dubois B, Holloway R, Jankovic J, Kulisevsky J, Lang AE, Lees A, Leurgans S, LeWitt PA, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, van Hilten JJ, LaPelle N, Movement Disorder Society URTF (2008) Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord Off J Mov Disord Soc 23(15):2129–2170. doi: 10.1002/mds.22340 CrossRefGoogle Scholar
  26. 26.
    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198CrossRefPubMedGoogle Scholar
  27. 27.
    Beck A, Steer R, Brown G (1996) Manual for the BDI-II. Psychol Corp, San AntonioGoogle Scholar
  28. 28.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370CrossRefPubMedGoogle Scholar
  29. 29.
    Marinus J, Visser M, van Hilten JJ, Lammers GJ, Stiggelbout AM (2003) Assessment of sleep and sleepiness in Parkinson disease. Sleep 26(8):1049–1054PubMedGoogle Scholar
  30. 30.
    Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE (2010) Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord Off J Mov Disord Soc 25(15):2649–2653. doi: 10.1002/mds.23429 CrossRefGoogle Scholar
  31. 31.
    Efron B, Tibshirani RJ (1993) An introduction to the bootstrap. Chapman & Hall, New YorkCrossRefGoogle Scholar
  32. 32.
    Hall JM, Shine JM, Walton CC, Gilat M, Kamsma YP, Naismith SL, Lewis SJG (2014) Early phenotypic differences between Parkinson’s disease patients with and without freezing of gait. Parkinsonism Relat Disord 20(6):604–607. doi: 10.1016/j.parkreldis.2014.02.028 CrossRefPubMedGoogle Scholar
  33. 33.
    Lewis SJG, Foltynie T, Blackwell AD, Robbins TW, Owen AM, Barker RA (2005) Heterogeneity of Parkinson’s disease in the early clinical stages using a data driven approach. J Neurol Neurosurg Psychiatry 76(3):343–348. doi: 10.1136/jnnp.2003.033530 PubMedCentralCrossRefPubMedGoogle Scholar
  34. 34.
    Rahman S, Griffin HJ, Quinn NP, Jahanshahi M (2008) The factors that induce or overcome freezing of gait in Parkinson’s disease. Behav Neurol 19(3):127–136CrossRefPubMedGoogle Scholar
  35. 35.
    Schrag A, Hovris A, Morley D, Quinn N, Jahanshahi M (2006) Caregiver-burden in parkinson’s disease is closely associated with psychiatric symptoms, falls, and disability. Parkinsonism Relat Disord 12(1):35–41. doi: 10.1016/j.parkreldis.2005.06.011 CrossRefPubMedGoogle Scholar
  36. 36.
    Vercruysse S, Vandenberghe W, Munks L, Nuttin B, Devos H, Nieuwboer A (2014) Effects of deep brain stimulation of the subthalamic nucleus on freezing of gait in Parkinson’s disease: a prospective controlled study. J Neurol Neurosurg Psychiatry 85(8):871–877. doi: 10.1136/jnnp-2013-306336 CrossRefPubMedGoogle Scholar
  37. 37.
    Mirelman A, Rochester L, Reelick M, Nieuwhof F, Pelosin E, Abbruzzese G, Dockx K, Nieuwboer A, Hausdorff JM (2013) V-TIME: a treadmill training program augmented by virtual reality to decrease fall risk in older adults: study design of a randomized controlled trial. BMC Neurol 13:15. doi: 10.1186/1471-2377-13-15 PubMedCentralCrossRefPubMedGoogle Scholar
  38. 38.
    Naismith SL, Mowszowski L, Diamond K, Lewis SJG (2013) Improving memory in Parkinson’s disease: a healthy brain ageing cognitive training program. Mov Disord Off J Mov Disord Soc 28(8):1097–1103. doi: 10.1002/mds.25457 CrossRefGoogle Scholar
  39. 39.
    Walton CC, Mowszowski L, Lewis SJG, Naismith SL (2014) Stuck in the mud: time for change in the implementation of cognitive training research in ageing? Front Aging Neurosci 6:43. doi: 10.3389/fnagi.2014.00043 PubMedCentralCrossRefPubMedGoogle Scholar
  40. 40.
    Nonnekes J, Janssen A, Mensink SG, Oude Nijhuis L, Bloem B, Snijders A (2014) Short rapid steps to provoke freezing of gait in Parkinson’s disease. J Neurol. doi: 10.1007/s00415-014-7422-8 Google Scholar
  41. 41.
    Walton C, Shine J, Mowszowski L, Gilat M, Hall J, O’Callaghan C, Naismith SL, Lewis SJG (2014) Impaired cognitive control in Parkinson’s disease patients with freezing of gait in response to cognitive load. J Neural Transm. doi: 10.1007/s00702-014-1271-6 PubMedGoogle Scholar
  42. 42.
    Naismith SL, Shine JM, Lewis SJG (2010) The specific contributions of set-shifting to freezing of gait in Parkinson’s disease. Mov Disord Off J Mov Disord Soc 25(8):1000–1004. doi: 10.1002/mds.23005 CrossRefGoogle Scholar
  43. 43.
    Wooten GF, Currie LJ, Bovbjerg VE, Lee JK, Patrie J (2004) Are men at greater risk for Parkinson’s disease than women? J Neurol Neurosurg Psychiatry 75(4):637–639. doi: 10.1136/jnnp.2003.020982 PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Courtney C. Walton
    • 1
    • 2
  • James M. Shine
    • 1
  • Julie M. Hall
    • 1
  • Claire O’Callaghan
    • 3
  • Loren Mowszowski
    • 1
    • 2
  • Moran Gilat
    • 1
  • Jennifer Y. Y. Szeto
    • 1
  • Sharon L. Naismith
    • 1
    • 2
  • Simon J. G. Lewis
    • 1
  1. 1.Parkinson’s Disease Research Clinic, Brain and Mind Research InstituteUniversity of SydneySydneyAustralia
  2. 2.Healthy Brain Ageing Program, Brain and Mind Research InstituteUniversity of SydneySydneyAustralia
  3. 3.Neuroscience Research Australia and School of Medical SciencesUniversity of New South WalesSydneyAustralia

Personalised recommendations