Diversity Supplement: SCH: Context-aware Freezing of Gait mitigation in real-world setting

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Project Summary This proposal is submitted in response to PA-21-071: Research Supplements to Promote Diversity in Health- Related Research. This supplement seeks to examine neuropsychological contributors to freezing of gait (FoG), which is suffered by over 50% of people living with Parkinson’s Disease (PD) in order to reduce FoG burden. FoG, a common, devastating manifestation of PD for which there is no cure or adequate medical or surgical treatment, has been defined as a “brief, episodic absence or marked reduction of forward progression of the feet, despite the intention to walk.” It is widely known that FoG episodes are frequently triggered by various environmental and psychological factors. The most commonly recognized triggers include start hesitation (freezing upon gait initiation), walking through tight quarters, turn hesitation (freezing when changing directions), approaching a visual target, dual tasking, and stressful, time-sensitive situations such as entering an elevator before the doors close. Each individual with PD is unique with regard to how sensitive they are to these various triggers, underscoring the need for customized therapeutic approaches. As such, increased understanding of modifiable factors underlying FoG for increased understanding of individual nuances in experiences of FoG is warranted. Although anxiety has been established as an important psychological mechanism driving FoG behavior, there remains little to no research on neuropsychological factors that may precede FoG-inducing anxious symptomatology. Indeed, although it is known that anxiety is a precursor to FoG behaviors in individuals diagnosed with Parkinson’s Disease, less is known about the mechanisms contributing to this anxiety and underlying the association between anxiety and FoG outcomes broadly. An emerging body of research suggests that objectively and subjectively measured sleep is associated with both 1) anxiety and 2) FoG outcomes in individuals diagnosed with PD. In order to address key research gaps, this supplement will collect subjective and objective indices of anxiety, sleep, and other neuropsychological factors that influence FoG outcomes in individuals living with PD to promote increased understanding of and inform treatment targeted toward reduced burden associated with this phenomenon.