Impacts of gait freeze on quality of life in Parkinson's disease, from the perspectives of patients and their carers

Abstract

Background: The World Health Organisation (WHO) reports that morbidity and mortality due to Parkinson's disease (PD) are increasing faster than for other neurodegenerative conditions. People with Parkinson's (PwP) present with a variety of motor symptoms, such as tremor, bradykinesia, and rigidity. Freezing of gait (FoG) is a significant motor symptom that manifests as temporary episodes of inability to move one's feet, despite the intention to walk.

Aims: This study examined the impact of FoG on quality of life (QoL) within an Irish cohort of PwP, from the perspectives of both PwP and their carers, using validated questionnaires that had been adapted for online use.

Methods: PwP and their carers were recruited by outreach to the Irish Parkinson's Community. Anonymous online questionnaires were distributed, which combined a demographic survey with several clinically validated surveys, including Freezing of Gait Questionnaire (FoG-Q), Parkinson's Disease Questionnaire 8 (PDQ-8), and Parkinson's Disease Carer Questionnaire (PDQ-C).

Results: There was a strong correlation (p < 0.001) between severity of FoG and lower QoL among PwP. Significant correlation was also found between FoG severity and several motor symptoms, such as postural instability and difficulty with balance, and non-motor symptoms, such as cognitive changes and pain/discomfort. FoG severity correlated with disease progression. Significant correlation was also found between FoG and symptoms, as assessed from the perspective of the patients' carers.

Conclusions: This study shows that FoG is a significant detriment to the QoL of PwP, from the perspectives of patients and carers. This method of assessing FoG and QoL using online questionnaires has potential to enhance the reach and flexibility of this type of research. These findings will inform future studies on larger cohorts and highlight unmet clinical needs in PwP.

Keywords: Caregivers; Freezing of gait; Gait freeze; Motor symptoms; Non-motor symptoms; Parkinson’s disease; Quality of life; e-Health.

Fig. 1

Survey design. PwP, person with PD; PDQ-8, The Parkinson’s Disease Questionnaire; PDQ-C, The Parkinson's Disease Questionnaire—Carer; FoG-Q, Freezing of Gait Questionnaire (modified for online use)

Fig. 2

Correlations between severity of FoG and motor and non-motor symptoms in PwP, as indicated by PwP. Graphs demonstrating correlations between FoG and motor and non-motor symptoms. Data shown are from questionnaires completed by PwP, and only those symptoms with statistically significant correlations are displayed. Analysis of correlations between motor/non-motor symptoms and FoG scores between groups was conducted by Mann-Whitney U testing; statistical significance was defined at p < 0.05. PwP, people with Parkinson’s disease.; PD, Parkinson’s disease; FoG-Q, modified Freezing of Gait Questionnaire

Fig. 3

Correlations between severity of FoG and motor and non-motor symptoms in PwP, as indicated by carers. Graphs demonstrating correlations between FoG and motor and non-motor symptoms. Data shown are from questionnaires completed by carers, and only those symptoms with statistically significant correlations are displayed. Analysis of correlations between motor/non-motor symptoms and FoG scores between groups was conducted by Mann-Whitney U testing; statistical significance was defined at p < 0.05. PwP, People with Parkinson’s disease; PD, Parkinson’s disease; FoG-Q, modified Freezing of Gait Questionnaire