Freezing of gait subtypes have different cognitive correlates in Parkinson's disease |
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| Institution: | 1. Department Perceptual and Cognitive Systems, TNO, Kampweg 5, 3769 DE Soesterberg, The Netherlands;2. Department of Information and Computing Sciences, Utrecht University, Princetonplein 5, 3584 CC Utrecht, The Netherlands;1. Department of Neurology and Psychiatry (Parkinson''s Centre), University “Sapienza”, Rome, Italy;2. I.R.C.C.S. Santa Lucia Foundation, Rome, Italy;3. Research Centre of Social Diseases (CIMS), University “Sapienza”, Rome, Italy;1. Chulalongkorn Center of Excellence for Parkinson''s Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand;2. Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan;3. Biomedical Signal Processing Laboratory, National Electronics and Computer Technology Center (NECTEC), Pathumthani, Thailand;4. The Maurice Wohl Clinical Neuroscience Institute, King’s College London and National Parkinson Foundation Centre of Excellence, King''s College Hospital, London, United Kingdom;1. Department of Neurology, YangPu Hospital, Tongji University School of Medicine, Shanghai 200092, China;2. Department of Neurology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu210008, China;3. Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China;1. Departamento de Farmacologia, Universidade Federal do Paraná, Curitiba 81.530-980, PR, Brazil;2. Department of Psychology, University of Sheffield, UK;3. Department of Psychiatry and Bowles Center for Alcohol Studies, University of North Carolina, Chapel Hill, NC 27599-7178, USA;1. Parkinson''s Disease Research Clinic, Brain and Mind Research Institute, University of Sydney, NSW, Australia;2. Centre for Human Movement Sciences, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands;3. Healthy Brain Ageing Program, Ageing Brain Centre, Brain and Mind Research Institute, University of Sydney, NSW, Australia |
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| Abstract: | BackgroundFreezing of gait (FOG) is a major concern for Parkinson's disease (PD) patients because it is a leading cause of falls and is associated with poor quality of life. The pathophysiology is unknown but it is hypothesized that it relates to cognitive abnormalities; particularly executive and visuospatial dysfunction. However, prior results have been discrepant. Pharmacologic subtypes of FOG include those that are responsive and unresponsive to levodopa.ObjectiveTo determine whether executive and visuospatial dysfunction are associated specifically with the levodopa unresponsive subtype of FOG.Methods135 PD subjects completed a single assessment included FOG questionnaire, UPDRS motor scale, comprehensive cognitive battery and measure of hallucinations. Analyses compared unresponsive (n = 16), responsive (n = 20) and no FOG (n = 99) subtypes.ResultsThe unresponsive subtype had a significantly older age of onset of PD than the responsive group (p = .03) and had worse motor scores (p = .003) than the no FOG group. Longer disease duration was associated with the responsive group compared to the no FOG group (p = .002). The unresponsive FOG group had significantly poorer visuospatial ability (p = .001) and executive functioning (p = .02) than both the no and responsive FOG subgroups. These latter groups were not significantly different. The responsive FOG group was associated with the presence of hallucinations.ConclusionAside from pharmacological differences, unresponsive FOG is associated with executive and visuospatial dysfunction implicating frontostriatal pathways while responsive FOG is associated with hallucinations suggesting involvement of posterior cortical regions. Further study and treatment of FOG should include appropriate subtype classification. |
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| Keywords: | Parkinson's disease Freezing of gait Executive dysfunction Visuospatial dysfunction Hallucinations |
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