- 作者：Anne F. Josiah ; Ann L. Gruber-Baldini ; Karen E. Anderson ; Paul S. Fishman ; William J. Weiner ; Stephen G. Reich ; Lisa M. Shulman ; lshulman@som.umaryland.edu
- 关键词：Impairment ; Freezing ; Parkinson&rsquo ; s disease
- 刊名：Parkinsonism and Related Disorders
- 出版年：2012
- 期刊代码：215_13538020
- 类别：med
- 出版时间：March, 2012
- 卷：18
- 期：3
- 页码：239-242
- 文件大小：313 K
Objective
To compare the effects of gait impairment without freezing of gait (FOG) versus FOG without gait impairment in Parkinson鈥檚 disease (PD) on disability and quality of life.Background
FOG is frequently characterized as the major cause of gait-related disability in PD. However, gait impairment may also result from other PD symptoms including slowing, motor asymmetry, gait variability, dystonia or stooped posture.
Methods
The Unified Parkinson鈥檚 Disease Rating Scale (UPDRS), Older Americans Resources and Services Disability Scale (OARS) and the SF-12 Health Status Survey were used to evaluate patients with PD. Responses to UPDRS Items #14 (Freezing) and # 29 (Gait) were used to create 4 subgroups: 1) No FOG or gait impairment, 2) FOG, no gait impairment, 3) Gait impairment, no FOG, and 4) Both FOG and gait impairment. Disease severity, disability, and quality of life were compared across the subgroups with ANOVAs, and between subgroups with t-tests.
Results
916 PD patients were divided into 4 subgroups based on their gait and freezing score (#1: n聽=聽213, #2: n聽=聽41, #3: n聽=聽323 and #4: n聽=聽339). Total UPDRS progressively increased from Group 1 through Group 4 (1聽=聽25.2, 2聽=聽33.7, 3聽=聽39.2, 4聽=聽59.2; p聽<聽0.001). Motor UPDRS also progressively increased (1聽=聽17.4, 2聽=聽19.7, 3聽=聽26.9, 4聽=聽36.5; p聽<聽0.0001). Similarly, disability and health-related quality of life progressively increased from Group 1 through Group 4 (Total OARS: 1聽=聽15.3, 2聽=聽17.2, 3聽=聽18.9, 4聽=聽28.4; p聽<聽0.001). Group 3 (Gait impairment, no FOG) showed greater disease severity than Group 2 (FOG, no gait impairment; Total and Motor UPDRS; p聽<聽0.05), but the difference did not reach significance for disability or quality of life.
Conclusions
Gait impairment without FOG was associated with greater disease severity than FOG without gait impairment. The combination of gait impairment and FOG was associated with the greatest disease severity and disability. These results show differential effects of diverse features of gait impairment in PD and demonstrate the importance of gait features unrelated to freezing.