Freezing of gait in patients with Parkinson’s disease: Provoking conditions and risk factors

Abstract

Background & Objective: Freezing of gait (FOG) in Parkinson’s disease (PD) significantly impacts patients’ quality of life. Determining whether a patient has FOG is a clinical challenge. We aimed to investigate an improved rapid clinical assessment method to detect FOG and its risk factors in PD patients.

Methods: This cross-sectional study involved 103 PD patients performing a walking trial designed to provoke FOG, which included tasks like 180-degree turns, navigating narrow corridors with obstacles, and 360-degree turns, both with and without a dual cognitive task of counting down from 100. Video recordings were examined to document freezers and non-freezers. Univariate analysis and multivariate logistic regression were used to determine risk factors. Receiver operating characteristic (ROC) curves were computed to obtain sensitivity and specificity of predictors of FOG.

Results: Turning 360 degrees counterclockwise while counting down from 100 provoked FOG in all patients with FOG. Freezers (26.2%) had significantly longer disease duration, higher disability, and greater use of levodopa (LEDD). Independent risk factors included Hoehn & Yahr stage >2.5 (OR=4.32; 95% CI: 1.16-16.09), motor fluctuation (OR=5.93; 95% CI: 1.86-18.88), and MDS-UPDRS part II (OR=1.10; 95% CI: 1.00-1.20). MDS-UPDRS part II cut off of 17 can predict FOG with a sensitivity of 55.6 % and specificity of 86.8 %.

Conclusions: A rapid clinical assessment involving a 360-degree counterclockwise turn with a cognitive task is effective for FOG detection. This method provides a quick, reliable screening tool in clinical practice, especially for patients with Hoehn & Yahr stage >2.5 and motor fluctuations.