Background <p>In people with Parkinson’s disease (PD), freezing of gait (FOG) can manifest as an absence of leg movement (akinetic) or a presence of high-frequency leg trembling. FOG is triggered most often during turning or dual-tasking when OFF-medication, but it is unclear whether the same holds true for akinetic and trembling FOG.</p> Objectives <p>To investigate the effects of dopaminergic medication and cognitive and motor tasks on trembling and akinetic FOG.</p> Method <p>Sixty-three PD patients with daily FOG performed a home-based FOG-provoking protocol OFF and ON-dopaminergic medication. FOG was video-annotated based on pre-specified definitions. We compared the % time in trembling and in akinetic FOG between OFF and ON. We also analyzed these outcomes during various motor tasks and with- and without a cognitive dual task. To identify subgroups, an exploratory k-means cluster analysis was performed.</p> Results <p>Trembling and akinetic FOG co-occurred in most patients (82.5%), although trembling was observed most frequently. Both manifestations were ameliorated by medication, but we identified four different patterns: a responsive mild group (<i>n</i> = 32), an unresponsive akinetic-dominant group (<i>n</i> = 8), and two trembling-dominant groups with (<i>n</i> = 12) and without (<i>n</i> = 11) a response to medication. Task load also affected the manifestations differentially, as dual-tasking and gait initiation induced more akinetic FOG compared to other conditions.</p> Conclusions <p>Trembling and akinetic FOG respond similarly to dopaminergic medication (except for a specific trembling subgroup), yet they are differentially influenced by FOG triggers. Altogether, we suggest that “trembling” may represent a milder form of FOG, although “trembling” as a distinct FOG-variant cannot be rule out.</p>

错误:搜索内容不能为空,请输入英文关键词
错误:关键词超出字数限制,请精简
高级检索

The effects of dopaminergic medication and task load on trembling and akinetic freezing of gait in Parkinson’s disease

  • Demi Zoetewei,
  • Pieter Ginis,
  • Talia Herman,
  • Moran Gilat,
  • Nicholas D’Cruz,
  • Luca Palmerini,
  • Eran Gazit,
  • Jeffrey M. Hausdorff,
  • Alice Nieuwboer

摘要

Background

In people with Parkinson’s disease (PD), freezing of gait (FOG) can manifest as an absence of leg movement (akinetic) or a presence of high-frequency leg trembling. FOG is triggered most often during turning or dual-tasking when OFF-medication, but it is unclear whether the same holds true for akinetic and trembling FOG.

Objectives

To investigate the effects of dopaminergic medication and cognitive and motor tasks on trembling and akinetic FOG.

Method

Sixty-three PD patients with daily FOG performed a home-based FOG-provoking protocol OFF and ON-dopaminergic medication. FOG was video-annotated based on pre-specified definitions. We compared the % time in trembling and in akinetic FOG between OFF and ON. We also analyzed these outcomes during various motor tasks and with- and without a cognitive dual task. To identify subgroups, an exploratory k-means cluster analysis was performed.

Results

Trembling and akinetic FOG co-occurred in most patients (82.5%), although trembling was observed most frequently. Both manifestations were ameliorated by medication, but we identified four different patterns: a responsive mild group (n = 32), an unresponsive akinetic-dominant group (n = 8), and two trembling-dominant groups with (n = 12) and without (n = 11) a response to medication. Task load also affected the manifestations differentially, as dual-tasking and gait initiation induced more akinetic FOG compared to other conditions.

Conclusions

Trembling and akinetic FOG respond similarly to dopaminergic medication (except for a specific trembling subgroup), yet they are differentially influenced by FOG triggers. Altogether, we suggest that “trembling” may represent a milder form of FOG, although “trembling” as a distinct FOG-variant cannot be rule out.