Motor, affective, cognitive, and perceptual symptom changes over time in individuals with Parkinson's disease who develop freezing of gait

Michelle V Faerman¹, Cayli Cole¹, Karen Van Ooteghem¹, Benjamin F Cornish¹, Erika E Howe¹, Verena Siu¹, Pershia Norouzian¹, Alanna Black², Julia E Fraser¹, David A Grimes^{3

4}, Mandar Jog², Donna Kwan⁵, Anthony E Lang⁶, Jane M Lawrence-Dewar⁷, Brian Levine^{8

9

10}, Connie Marras⁶, Mario Masellis^{9

11}, William E McIlroy¹, Paula M McLaughlin^{12

13

14}, Manuel Montero-Odasso^{15

16

17}, J B Orange¹⁸, Alicia J Peltsch¹⁹, Frederico Pieruccini-Faria^{15

16

17}, Angela C Roberts^{18

20}, Yanina Sarquis-Adamson^{16

17}, Thomas D L Steeves²¹, Brian Tan⁹, Angela K Troyer^{10

22}; ONDRI Investigators; Kaylena A Ehgoetz Martens²³

Collaborators, Affiliations

Collaborators

ONDRI Investigators:
Michael Strong, Peter Kleinstiver, Natalie Rashkovan, Susan Bronskill, Sandra E Black, Michael Borrie, Elizabeth Finger, Corinne Fischer, Andrew Frank, Morris Freedman, Sanjeev Kumar, Stephen Pasternak, Bruce Pollock, Tarek Rajji, Dallas Seitz, David Tang-Wai, Carmela Tartaglia, Brenda Varriano, Agessandro Abrahao, Marvin Chum, Christen Shoesmith, John Turnbull, Lorne Zinman, Jane Lawrence-Dewar, Julia Fraser, Bill McIlroy, Ben Cornish, Frederico Pieruccini-Faria, Barry Greenberg, Wendy Hatch, Chris Hudson, Elena Leontieva, Ed Margolin, Efrem Mandelcorn, Faryan Tayyari, Sherif Defrawy, Don Brien, Ying Chen, Brian Coe, Doug Munoz, Alisia Bonnick, Leanne Casaubon, Dar Dowlatshahi, Ayman Hassan, Jennifer Mandzia, Demetrios Sahlas, Gustavo Saposnik, Richard H Swartz, David Breen, David Grimes, Anthony Lang, Tom Steeves, Dennis Bulman, Allison Ann Dilliott, Mahdi Ghani, Rob Hegele, John Robinson, Ekaterina Rogaeva, Sali Farhan, Rob Bartha, Hassan Haddad, Nuwan Nanayakkara, Joel Ramirez, Christopher Scott, Sean Symons, Courtney Berezuk, Melissa Holmes, Sabrina Adamo, Miracle Ozzoude, Mojdeh Zamyadi, Stephen Arnott, Derek Beaton, Malcolm Binns, Wendy Lou, Pradeep Raamana, Stephen Strother, Kelly Sunderland, Athena Theyers, Abiramy Uthirakumaran, Guangyong Zou, Sujeevini Sujanthan, Mojdeh Zamyadi, David Munoz, Roger A Dixon, John Woulfe, Paula McLaughlin, Alicia Peltsch, Angela Roberts, Angela Troyer

Affiliations

¹ Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada.
² London Health Sciences Centre, London, ON, Canada.
³ Department of Medicine (Neurology), University of Ottawa, Ottawa, ON, Canada.
⁴ Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁵ Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
⁶ Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, Toronto, ON, Canada.
⁷ Thunder Bay Regional Health Research Institute, Thunder Bay, ON, Canada.
⁸ Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada.
⁹ Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada.
¹⁰ Department of Psychology, University of Toronto, Toronto, ON, Canada.
¹¹ Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹² Nova Scotia Health, Halifax, NS, Canada.
¹³ Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS, Canada.
¹⁴ Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
¹⁵ Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
¹⁶ Lawson Health Research Institute, London, ON, Canada.
¹⁷ Gait and Brain Lab, Parkwood Institute, London, ON, Canada.
¹⁸ School of Communication Sciences and Disorders, Faculty of Health Sciences, Western University, London, ON, Canada.
¹⁹ Faculty of Engineering and Applied Science, Queen's University, Kingston, ON, Canada.
²⁰ Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA.
²¹ Division of Neurology, St. Michael's Hospital, Toronto, ON, Canada.
²² Neuropsychology and Cognitive Health, Baycrest Health Sciences, Toronto, ON, Canada.
²³ Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada. kaehgoet@uwaterloo.ca.

PMID: 40198411
DOI: 10.1007/s00415-025-13034-y

Motor, affective, cognitive, and perceptual symptom changes over time in individuals with Parkinson's disease who develop freezing of gait

Michelle V Faerman et al. J Neurol. 2025.

. 2025 Apr 8;272(5):321.

doi: 10.1007/s00415-025-13034-y.

Authors

Collaborators

ONDRI Investigators:
Michael Strong, Peter Kleinstiver, Natalie Rashkovan, Susan Bronskill, Sandra E Black, Michael Borrie, Elizabeth Finger, Corinne Fischer, Andrew Frank, Morris Freedman, Sanjeev Kumar, Stephen Pasternak, Bruce Pollock, Tarek Rajji, Dallas Seitz, David Tang-Wai, Carmela Tartaglia, Brenda Varriano, Agessandro Abrahao, Marvin Chum, Christen Shoesmith, John Turnbull, Lorne Zinman, Jane Lawrence-Dewar, Julia Fraser, Bill McIlroy, Ben Cornish, Frederico Pieruccini-Faria, Barry Greenberg, Wendy Hatch, Chris Hudson, Elena Leontieva, Ed Margolin, Efrem Mandelcorn, Faryan Tayyari, Sherif Defrawy, Don Brien, Ying Chen, Brian Coe, Doug Munoz, Alisia Bonnick, Leanne Casaubon, Dar Dowlatshahi, Ayman Hassan, Jennifer Mandzia, Demetrios Sahlas, Gustavo Saposnik, Richard H Swartz, David Breen, David Grimes, Anthony Lang, Tom Steeves, Dennis Bulman, Allison Ann Dilliott, Mahdi Ghani, Rob Hegele, John Robinson, Ekaterina Rogaeva, Sali Farhan, Rob Bartha, Hassan Haddad, Nuwan Nanayakkara, Joel Ramirez, Christopher Scott, Sean Symons, Courtney Berezuk, Melissa Holmes, Sabrina Adamo, Miracle Ozzoude, Mojdeh Zamyadi, Stephen Arnott, Derek Beaton, Malcolm Binns, Wendy Lou, Pradeep Raamana, Stephen Strother, Kelly Sunderland, Athena Theyers, Abiramy Uthirakumaran, Guangyong Zou, Sujeevini Sujanthan, Mojdeh Zamyadi, David Munoz, Roger A Dixon, John Woulfe, Paula McLaughlin, Alicia Peltsch, Angela Roberts, Angela Troyer

Affiliations

¹ Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada.
² London Health Sciences Centre, London, ON, Canada.
³ Department of Medicine (Neurology), University of Ottawa, Ottawa, ON, Canada.
⁴ Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁵ Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
⁶ Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, Toronto, ON, Canada.
⁷ Thunder Bay Regional Health Research Institute, Thunder Bay, ON, Canada.
⁸ Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada.
⁹ Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada.
¹⁰ Department of Psychology, University of Toronto, Toronto, ON, Canada.
¹¹ Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹² Nova Scotia Health, Halifax, NS, Canada.
¹³ Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS, Canada.
¹⁴ Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
¹⁵ Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
¹⁶ Lawson Health Research Institute, London, ON, Canada.
¹⁷ Gait and Brain Lab, Parkwood Institute, London, ON, Canada.
¹⁸ School of Communication Sciences and Disorders, Faculty of Health Sciences, Western University, London, ON, Canada.
¹⁹ Faculty of Engineering and Applied Science, Queen's University, Kingston, ON, Canada.
²⁰ Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA.
²¹ Division of Neurology, St. Michael's Hospital, Toronto, ON, Canada.
²² Neuropsychology and Cognitive Health, Baycrest Health Sciences, Toronto, ON, Canada.
²³ Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada. kaehgoet@uwaterloo.ca.

PMID: 40198411
DOI: 10.1007/s00415-025-13034-y

Abstract

Freezing of gait (FOG) affects up to 80% of individuals living with advanced Parkinson's disease and approximately 20% in early stages. Associated with motor, affective, cognitive, and sensory difficulties, FOG is challenging to treat due to its unknown etiology. Approaches and findings in research studies predicting FOG remain inconsistent. To help address discrepant methods and results, this prospective, longitudinal study evaluated motor, affective, cognitive, and perceptual predictors of FOG. Data from 120 individuals with idiopathic Parkinson's disease from the Ontario Neurodegenerative Disease Research Initiative cohort were analyzed across two years to evaluate the strongest FOG predictors. Over this period, 25 individuals developed FOG (transitional freezers), 71 remained non-freezers, and the remaining 24 participants experienced freezing at baseline and follow-up (continuous freezers). Two-way Time*Group ANOVAs and non-parametric equivalents assessed data longitudinally. Separate logistic regression models evaluated FOG predictors one and two years prior to onset. Transitional freezers showed lower baseline immediate verbal recall z-scores than non-freezers. Transitional freezers' dyskinesia severity, postural instability/gait difficulty, and depression increased, and attentional set-shifting and delayed visuospatial memory declined. Motor symptoms and longer disease duration predicted FOG two years prior, with affective and cognitive measures predictive one year prior. Models had high specificity (2 years: 97.0%, 1 year: 90.4%) but not sensitivity (2 years: 43.8%, 1 year: 52.9%), with accuracies of 86.7% and 81.2%, respectively. These findings highlight the change in FOG predictors relative to its onset time, which might explain conflicting findings to date. Future work should consider whether predictors vary by disease stage or FOG 'subtype'.

Keywords: Freezing of gait; Parkinson’s disease; Prediction; Risk factors.

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Conflict of interest statement

Declarations. Conflicts of interest: The authors have no relevant financial or non-financial interests to disclose. Ethical approval: This study was approved by the University of Waterloo Research Ethics Board. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this work is consistent with those guidelines.

References

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Motor, affective, cognitive, and perceptual symptom changes over time in individuals with Parkinson's disease who develop freezing of gait

Collaborators

Affiliations

Motor, affective, cognitive, and perceptual symptom changes over time in individuals with Parkinson's disease who develop freezing of gait

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical