Frozen Gait in Parkinson's Disease Is Influenced by Emotional Stimuli

Monday, February 05, 2018

In a study published in Movement Disorders, Lagravinese and colleagues have shown that gait initiation in patients with Parkinson’s disease (PD) is affected by the presence of an emotional stimuli (Movement Disorders. 2018;33:published online February 2, 2018). Subjects with PD and frozen gait (n = 15), subjects with PD and without frozen gait (n = 15), and subjects with neither (normal controls, n = 14) were asked to step both forward and backward upon seeing a pleasant or unpleasant image. Stepping forward to a pleasant image is a congruent task with lower cognitive load than stepping forward to an unpleasant image, which is considered an incongruent task with high cognitive load. The reverse is true for stepping backward in response to a pleasant image.

Researchers measured several aspects of gait initiation including reaction time, anticipatory postural adjustments, step size, and sway paths. They found that patients with PD and frozen gait had a longer reaction time and a shorter step size when stepping forward in response to an unpleasant image (incongruent task). Change in reaction time remained significant after adjusting for cognitive functions of their subjects. Changes in reaction time in the incongruent task also correlated with the frequency of freezing for subjects with PD and frozen gait.

Frozen gait occurs in over half of patients with Parkinson’s disease and has a significant impact on patient’s mobility and in turn, their quality of life. This study suggests that the limbic system is involved in frozen gait, providing another therapeutic target for treatment of this aspect of PD. The study also suggests that mentally visualizing something pleasant during exercise programs may help patients with PD and frozen gait initiate gait, making exercise therapies more effective for those patients. 

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