Journal of neurology · 2025
The effects of dopaminergic medication and task load on trembling and akinetic freezing of gait in Parkinson's disease.
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Zoetewei Demi, Ginis Pieter, Herman Talia, Gilat Moran, D'Cruz Nicholas, Palmerini Luca, Gazit Eran, Hausdorff Jeffrey M, Nieuwboer Alice
Аннотация
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.
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.