Anxiety Independently Contributes to Severity of Freezing of Gait in People With Parkinson’s Disease
Abstract
Methods
Participants
Assessments
Statistical Analysis
Results
Participant Characteristics and Comparisons Between Freezers and Nonfreezers
Variable | Participants With Freezing of Gait (N=27) | Participants Without Freezing of Gait (N=51) | |||||||
---|---|---|---|---|---|---|---|---|---|
Median (Range) | Median (Range) | p | |||||||
Demographic characteristic | |||||||||
Age (years) | 71 (61–85) | – | – | – | 68 (60–89) | – | – | – | 0.010b |
Mean | SD | N | % | Mean | SD | N | % | p | |
Sex, male | N/A | – | 16 | 59 | N/A | – | 26 | 51 | 0.485c |
History of ≥2 falls | N/A | – | 17 | 63 | N/A | – | 6 | 12 | <0.001c |
Parkinson’s disease severity | |||||||||
Unified Parkinson’s Disease Rating Scale, motor (0–108) | 39.8 | 9.9 | – | – | 28.4 | 11.7 | – | – | <0.001d |
Median (Range) | Median (Range) | p | |||||||
Hoehn and Yahr (0–5) | 3.0 (2–4) | – | – | – | 2.5 (1.5–3) | – | – | – | <0.001b |
Parkinson’s disease duration (years) | 9.0 (2–20) | – | – | – | 4.0 (1–14) | – | – | – | <0.001b |
Parkinson’s disease medication | |||||||||
Levodopa equivalent dose (mg/day) | 800 (466–1,962.5) | – | – | – | 532 (150–1,962.5) | – | – | – | <0.001b |
Mean | SD | N | % | Mean | SD | N | % | p | |
Parkinson’s disease symptoms | |||||||||
Motor fluctuations | N/A | – | 14 | 52 | N/A | – | 16 | 31 | 0.077c |
Dyskinesias | N/A | – | 8 | 30 | N/A | – | 6 | 12 | 0.066e |
Montreal Cognitive Assessment (N=58) | 15.9 | 4.8 | – | – | 17.9 | 4.6 | – | – | 0.111d |
Hospital Anxiety and Depression Scale total score (0–42) | 17.6 | 5.8 | – | – | 12.1 | 6.6 | – | – | 0.001d |
Median (Range) | Median (Range) | p | |||||||
Hospital Anxiety and Depression Scale, anxiety subscale score (0–21) | 9.0 (1–18) | – | – | – | 5.0 (0–15) | – | – | – | 0.002b |
Mean | SD | N | % | Mean | SD | N | % | p | |
Hospital Anxiety and Depression Scale, anxiety subscale ≥8 points | N/A | – | 19 | 70 | N/A | – | 16 | 31 | 0.001c |
Hospital Anxiety and Depression Scale, depression subscale (0–21) | 9.1 | 2.9 | – | – | 6.7 | 4 | – | – | 0.006d |
Hospital Anxiety and Depression Scale, depression subscale ≥8 points | N/A | – | 18 | 67 | N/A | – | 20 | 39 | 0.021c |
Disability | |||||||||
Median (Range) | Median (Range) | p | |||||||
Schwab and England (0%–100%)f | 80 (50–100) | – | – | – | 90 (70–100) | – | – | – | <0.001b |
Mean | SD | N | % | Mean | SD | N | % | p | |
Unified Parkinson’s Disease Rating Scale-activities of daily living (0–52) | 18.7 | 6.3 | – | – | 10.0 | 5.5 | – | – | <0.001d |
Balance confidence | |||||||||
Activities-Specific Balance Confidence Scale (0%–100%)f | 39.0 | 24.2 | – | – | 59.2 | 21.5 | – | – | <0.001d |
Quality of life | |||||||||
Median (Range) | Median (Range) | p | |||||||
8-item Parkinson’s Disease Questionnaire (0–100) | 40.6 (6.2–75) | – | – | – | 25 (0–68.7) | – | – | – | <0.001b |
Participants With Freezing of Gait (N=27)a | ||
---|---|---|
FOG-Q Item | N | % |
Item 3: Do you feel that your feet get glued to the floor while walking, making a turn or when trying to initiate walking (freezing)? | ||
Very rarely (about once a month) | 4 | 14.8 |
Rarely (about once a week) | 7 | 25.9 |
Often (about once a day) | 14 | 51.9 |
Always (whenever walking) | 2 | 7.4 |
Item 4: How long is your longest freezing episode? | ||
1–2 seconds | 7 | 25.9 |
3–10 seconds | 15 | 55.6 |
11–30 seconds | 2 | 7.4 |
Unable to walk for more than 30 seconds | 3 | 11.1 |
Item 5: How long is your typical start hesitation episode (freezing when initiating the first step)? | ||
None | 6 | 22.2 |
Takes longer than 1 second to start walking | 9 | 33.3 |
Takes longer than 3 seconds to start walking | 8 | 29.6 |
Takes longer than 10 seconds to start walking | 4 | 14.8 |
Item 6: How long is your typical turning hesitation (freezing when turning)? | ||
None | 4 | 14.8 |
Resume turning in 1–2 seconds | 10 | 37 |
Resume turning in 3–10 seconds | 10 | 37 |
Resume turning in 11–30 seconds | 2 | 7.4 |
Unable to resume turning for more than 30 seconds | 1 | 3.7 |
FOG-Q | FOG-Q Severity Scoresa | Activities-Specific Balance Confidence Scale | ||||
---|---|---|---|---|---|---|
Variable | rho | p | rho | p | rho | p |
Hospital Anxiety and Depression Scale | 0.52 | <0.001 | 0.39 | <0.001 | –0.53 | <0.001 |
Hospital Anxiety and Depression Scale, anxiety subscale | 0.44 | <0.001 | 0.36 | 0.001 | –0.52 | <0.001 |
Hospital Anxiety and Depression Scale, depression subscale | 0.48 | <0.001 | 0.32 | 0.004 | –0.40 | <0.001 |
Activities-Specific Balance Confidence Scale | –0.62 | <0.001 | –0.41 | <0.001 | — | — |
Univariate Analysis
Variable | B | 95% CI | p |
---|---|---|---|
Demographic characteristic | |||
Age (years) | 0.09 | –0.04, 0.23 | 0.183 |
Sex | –0.12 | –1.92, 1.68 | 0.895 |
History of ≥2 falls | 4.19 | 2.48, 5.91 | <0.001 |
Parkinson’s disease severity | |||
Parkinson’s disease duration (years) | 0.43 | 0.24, 0.61 | <0.001 |
Hoehn and Yahr scale score | 4.24 | 2.84, 5.64 | <0.001 |
Unified Parkinson’s Disease Rating Scale, motor score | 0.12 | 0.05, 0.19 | 0.001 |
Parkinson’s disease symptoms | |||
Motor fluctuations | 2.22 | 0.45, 3.99 | 0.014 |
Dyskinesias | 1.92 | –0.37, 4.22 | 0.099 |
Montreal Cognitive Assessment (N=58) | –0.19 | –0.42, 0.03 | 0.095 |
Hospital Anxiety and Depression Scale, anxiety subscale ≥8 points | 2.92 | 1.24, 4.59 | 0.001 |
Hospital Anxiety and Depression Scale, depression subscale ≥8 points | 1.72 | –0.03, 3.47 | 0.053 |
Parkinson’s disease medication | |||
Levodopa equivalent dose (per 100 mg/day) | 0.38 | 0.17, 0.59 | 0.001 |
Balance confidence | |||
Activities-Specific Balance Confidence scale score | –0.06 | –0.10, –0.03 | <0.001 |
Multivariate Analysis
Variable | B | 95% CI | p | Adjusted R2 |
---|---|---|---|---|
Hoehn and Yahr scale score | 3.56 | 2.22, 4.90 | <0.001 | 0.315 |
Hospital Anxiety and Depression Scale, anxiety subscale ≥8 points | 1.89 | 0.47, 3.31 | 0.010 | 0.385 |
Levodopa equivalent dose (per 100 mg/day) | 0.21 | 0.02, 0.39 | 0.026 | 0.417 |
Discussion
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