Depression in Patients With Parkinson Disease May Predict Freezing of Gait Risk

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Geriatric Depression Scale, gait speed and UPDRS-III were significant independent predictors of freezing gait.
Geriatric Depression Scale, gait speed and UPDRS-III were significant independent predictors of freezing gait.

Depressive symptoms, significant decreases in disease severity scores when off medication, and slower gait speed in patients with Parkinson disease appear to be strong, independent predictors of the development of freezing of gait, according to a study published in Parkinsonism and Related Disorders.

To identify predictors of freezing of gait in Parkinson disease, researchers evaluated 57 patients with Parkinson disease and without freezing of gait to establish a baseline and then re-evaluated the patients after approximately 5 years. Baseline assessments included disease severity as measured by the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) both on and off medication cycles, cognition, balance, gait under single and dual-tasking, and other non-motor symptoms. Freezing of gait was determined using the new-FOG-questionnaire (NFOG-Q). Independent predictors of freezing of gait were determined using multivariate binary logistic regression.

At follow-up, 46% of participants (n=26) had developed freezing of gait and 54% (n=31) remained nonfreezers. Nonfreezers and freezers had been similar with respect to gender, age, disease duration, cognitive function, and dopaminergic medications at baseline (P>.10), but freezers showed significantly worse scores than nonfreezers on the Berg Balance Scale, the UPDRS-part I, the UPDRS-part III (off medication), the NMS-questionnaire, the PDQ-39, and the Geriatric Depression Scale (GDS)(5.15±3.68 vs 2.45±2.03, P=.005). Using binary logistic regression, the only significant independent predictors of developing freezing of gait were slower gait speed, significant change in UPDRS-III off medication, and depressive symptoms (ΔUPDRS-III: odds ratio 1.34; P=.006, GDS: odds ratio 10.93, P=.003). Overall, whereas only 27% of participants with few symptoms of depression at baseline became freezers, 80% of participants with marked depressive symptoms (GDS>5) at baseline developed freezing of gait (P<.001).

Study investigators conclude that "[w]hile elucidation of the relationship between depression and [freezing of gait] needs further study, our findings offer another perspective regarding the pathophysiology of [freezing of gait] and may help clinicians to estimate the risk of developing this debilitating phenomenon."

Reference

Herman T, Shema-Shiratzky S, Arie L, Giladi N, Hausdorff JM. Depressive symptoms may increase the risk of the future development of freezing of gait in patients with Parkinson's disease: Findings from a 5-year prospective study [September 11, 2018]. Parkinsonism Relat Disord. doi: 10.1016/j.parkreldis.2018.09.013

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