Clinical Characteristics And Relevant Researchs In PD Patients With Freezing Of Gait

Part Ⅰ Clinical characteristics in PD patients with freezing of gait andthe correlation factors of FOGObjective: To study the Clinical characteristics, the common clinical manifestation,incidence and to determine the relevant risk factors of freezing of gait in patients withParkinson’s disease.Method:191consecutive patients with Parkinson’s disease were screened. RecruitedPD patients were classified into two groups: PD patients with FOG (PD+FOG) calledfreezers and without FOG (PD-FOG) called non-freezers, based on clinical manifestationand the results of the FOG-Q. Motor function was evaluated using the Unified Parkinson’sDisease Rating Scale (UPDRS) and Freezing of gait questionnaire (FOG-Q). Simultaneously,HAMD and MoCA were used to evaluate depression in recent a month and cognitiveimpairment. Freezers and non-freezers were compared using statistical univariate analysis,followed by bivariate and multivariate logistic regression.Result:104patients (54.4%) reported freezing of gait. FOG at the initiation of gait wasreported by81patients (77.8%of freezers), FOG on turning by64patients (61.5%offreezers) and FOG while walking, particularly in narrow spaces, was reported by35patients(33.7%of freezers). Freezers had longer disease duration, increased incidence of thepredominant motor signs (tremor/akinesia-rigidity subtypes) at the onset of Parkinson’sdisease, and increased disease severity according to the UPDRS (part III), Hoehn and Yahr.Compared to those without FOG, the PD patients with FOG had higher doses of levodopaas well as levodopa equivalent doses. In addition, freezers scored worse in the MoCA,experienced falls and depressions more frequently than non-freezers with significantlyhigher score of HAMD. Non-conditional multivariate logisitic regression analysis showedthat Hoehn and Yahr stage, UPDRS (part Ⅱ) and fall were the major influencing factors ofFOG. Conclusion: PD patients have a high incidence of FOG, in which FOG at the initiationof gait, on turning are more common. PD patients with FOG have longer disease duration,more severe disease, accompanied by mild depression, significant cognitive impairment andgreat risk of falls. Disease severity, daily living skills and falls are closely associated withFOG.Part Ⅱ The concurrent contributions of cognitive and affectivedisturbance to freezing of gait in Parkinson’s diseaseObjective: To study the non-motor symptoms and concurrently examine the specificmotor, cognitive and affective contributions to self-reported FOG symptoms.Method:104patients with Parkinson’s disease completed the validated freezing of gaitquestionnaire and had their motor function scored on section three of the Unified Parkinson’sDisease Rating Scale questionnaire and Hoehn and Yahr stage. HAMD and MoCA were usedto evaluate depression in recent a month and cognitive impairment.Result: Among104patients, the average scores of the UPDRS (part Ⅲ), Hoehn andYahr, FOG-Q, MoCA and HAMD were31.98±13.98,2.50±0.67,9.23±5.11,20.10±5.89and10.91±9.35separately, having no significant difference between male and female. Theincidence of cognitive impairment and depression were82.9%and55.8%. Statisticallysignificant differences existed in the subscores of MoCA between PD patients with andwithout cognitive impairment, in whichthe subscore of visuospatial and executive functiondecreased significantly. Pearson correlation analysis showed FOGQ and HY, UPDRS,HAMD and other scales were positively correlated, negatively correlated with MoCA.Multiple linear regression analysis showed MoCA, UPDRS Ⅱ, UPDRS Ⅲ, HAMD wereall the independent factors of FOG. MoCA, HAMD score at different ages and age of onset,duration of the different groups were not statistically different.Conclusion: PD patients with the freezing of gait always experience severe motorsymptoms, associated with significant cognitive dysfunction and depression. More severesymptoms in patients with FOG, the higher score of HAMD, together with higher occurrencerate of depression and more severe cognitive impairment. These findings suggest the needto consider the interplay between distinct motor, cognitive and affective domains inaetiological studies of freezing and the development of future therapies. Part Ⅲ Serum urate levels in PD patients with freezing of gaitObjective: To observe serum urate levels in PD patients with freezing of gait, and toexplore the relationship between serum urate levels and the freezing of gait, providing alaboratory basis for freezing of gait.Method:93PD patients and64normal controls were recruited. Recruited PD patientswere classified into two groups: PD patients with FOG (PD+FOG) and without FOG (PD-FOG), based on clinical manifestation and the results of the FOG-Q. The total levels ofplasma urate and Scr were quantitatively assessed in all participants.Result: Serum urate levels were significantly decreased in the PD+FOG group(258.58±58.15μmol/L) compared to control group (327.77±60.23μmol/L); while, significantdifference was found between the PD+FOG and PD-FOG groups (285.58±64.65μmol/L).There was no linear correlation between urate levels and FOGQ score.Conclusion: The serum urate levels of freezers was significantly lower than non-freezer and normal healthy people, suggesting that urate levels may affect FOG. The levelof uric acid cannot be as an indicator to determine the severity of the freezing of gait.