Anxiety May Help Predict Freezing of Gait in Parkinson Disease

senior man using a walker
senior man using a walker
The findings suggest that efforts to help prevent anxiety may help reduce risk for gait freezing.

Anxiety and positive responses to the Freezing of Gait-Questionnaire (FOG-Q3) are key predictors clinicians can use to assess risk for freezing of gait (FOG) in patients with Parkinson disease (PD), according to findings published in Movement Disorders.

Investigators evaluated longitudinal data from patients with PD (n=221) from the Parkinson’s Disease Research Clinic at the University of Sydney in Australia between 2008 and 2016. All patients were interviewed at least twice and were divided into 3 groups based upon responses to item 3 of the Freezing of Gait-Questionnaire (FOG-Q3) at both baseline and follow-up. These 3 groups included nonfreezers (n=88), transitional freezers (n=41), and continuing freezers (n=92).

The researchers found overall group effects for dopamine dose equivalence ([DDE] P =.001), Unified Parkinson’s Disease Rating Scale motor subsection ([UPDRS-III] P <.001), tremor dominant (TD)/non-TD ratio (P <.001), Mini-Mental State Examination ([MMSE] P <.001), Digit Span (DS)-Backwards (P =.002), Trail Making Test part A and B ([TMT-B-A] P =.003), and Hospital Anxiety and Depression Scale ([HADS-A] P <.001).

A risk prediction model consisting of nonfreezers (n=52) and transitional freezers (n=23) found that FOG-Q total (P =.01), HADS-A (P =.001), and HADS-D (P =.067) represented good predictors for FOG, with a predictive success of 84%. For the HADS-A and HADS-D, anxiety was found to be the strongest predictor for FOG in patients with PD.

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A lack of DDE data caused the study to exclude DDE from the logistic regression analysis, potentially limiting the study findings.

The investigators note that anxiety “should be targeted as part of preventive efforts for potential freezers” and indicates further research is needed to determine how this targeted therapy could delay onset of FOG.


Ehgoetz Martens KA, Lukasik EL, Georgiades MJ, et al. Predicting the onset of freezing of gait: A longitudinal study [published online November 18, 2017]. Mov Disord. doi:10.1002/mds.27208