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Prevalence of freezing of gait in Parkinson’s disease: a systematic review and meta-analysis

Journal of Neurology volume 268, pages 4138–4150 (2021)Cite this article

A Correction to this article was published on 24 August 2021

This article has been updated

Abstract

Background

Freezing of gait (FOG) is considered one of the most disturbing and least understood symptoms in Parkinson’s disease (PD). The reported prevalence rates of FOG in PD vary widely, ranging from 5 to 85.9%.

Objective

We conducted a systematic review and meta-analysis to provide a reliable estimate of the average point prevalence of FOG in PD, and we further investigated the study characteristics that might have influenced the estimate.

Methods

We searched different databases to identify studies that report the prevalence of FOG in PD or include relevant raw data for further calculation. The last inclusion date was February 20, 2020. The modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used for the quality assessment, and articles that met the predefined criteria were included in the quantitative analysis.

Results

Sixty-six studies were selected from 3392 references. A weighted prevalence of 50.6% in 9072 PD patients experienced FOG based on the special questionnaires (the FOG-Q and NFOG-Q), which was about twice as high as that assessed by the specific items of the clinical rating scales (UPDRS item2.14 and MDS-UPDRS item3.11) (23.2%) or simple clinical questions (25.4%). The weighted prevalence was 37.9% for early stage (≤ 5 years) and 64.6% for advanced stage (≥ 9 years). Moreover, a higher prevalence was calculated from the population-based studies than that in multicenter and single-center studies (47.3% vs. 33.5% and 37.1%, respectively).

Conclusion

The result from this systematic review confirms that FOG is very common in PD and its prevalence is usually underestimated in hospital settings. Importantly, a more accurate assessment of FOG in future clinical researches would involve the use of special FOG scale rather than a single item on a scale or a general clinical inquiry.

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Acknowledgements

We thank Professor Jussara Almeida Oliveira Baggio from Department of Neuroscience and Behavior, School of Medicine at Ribeirão Preto, Universidade de São Paulo for kindly providing the original data for a selected study in this review. This work was supported by grants from the National Natural Science Foundation of China (81771374).

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  1. Wei-Shan Zhang and Chao Gao contributed equally to this article.

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  1. Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Wei-Shan Zhang, Chao Gao, Yu-Yan Tan & Sheng-Di Chen

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Contributions

W-SZ, GC, and S-DC designed the study. S-DC oversaw its implementation. W-SZ, GC, and Y-YT coordinated the main review activities including searches, study selection, data extraction, and quality assessment. W-SZ and CG planned and did the meta-analyses. W-SZ wrote the report. S-DC reviewed and revised the first draft of this article.

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Correspondence to Sheng-Di Chen.

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The original online version of this article was revised: There are some wrong order of references. Full information regarding the corrections made can be found in the erratum/correction for this article.

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Zhang, WS., Gao, C., Tan, YY. et al. Prevalence of freezing of gait in Parkinson’s disease: a systematic review and meta-analysis. J Neurol 268, 4138–4150 (2021). https://doi.org/10.1007/s00415-021-10685-5

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