FREEZING OF GAIT, BRADYKINESIA & PARKINSONS DISEASE

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。步态冻结(雾)的病理生理学机制及其与其他帕金森症状的关系尚不清楚。为了深入了解这些运动障碍，我们评估了雾和帕金森病(PD)的其他帕金森病特征之间的关系以及左旋多巴的反应。对19例临床上有明显雾的PD患者在服用抗帕金森病药物12小时后处于“关闭”状态，以及在服用常规左旋多巴后约1小时处于“开启”状态。评估包括统一的帕金森氏病评定量表(UPDRS)和130米的录像步行。三名观察员独立观看了录像带，并记录了雾的频率。通过将相关的UPDRS条目分组，分析帕金森病的特征。三个观察者之间的观察者间和组内信度通过皮尔逊和弗里德曼检验进行评估。皮尔逊相关系数被用来评估雾和其他帕金森病特征之间的关系。三名观察员之间的一致程度很高(R=0.7)。雾化频率与“关”时的其他帕金森症状的严重程度无关，而只与“开”时的言语和书写严重程度指数相关。经左旋多巴治疗后，雾化频率明显减少。这种减少与震颤(R=0.80)和言语指数(R=0.62)的改善密切相关。未发现左旋多巴对雾化的反应与僵直、运动迟缓或平衡指数的改善之间的相关性。左旋多巴治疗可减少帕金森病患者的雾化频率。雾显然是帕金森病的一种独立的运动症状，由一种不同于运动迟缓、僵硬或姿势不稳定的阵发性病理引起。正在进行的研究旨在了解帕金森病患者这种特有的步态障碍的机制。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The pathophysiology of freezing of gait (FOG) and its relationship to other Parkinsonian symptoms is unclear. To gain insight into these motor disturbances, we assessed the relationship between FOG and other Parkinsonian features in Parkinson's disease (PD) and the response to levodopa. 19 PD patients with clinically significant FOG at "off" state were assessed while in "off" state, 12 hours after taking their anti-Parkinsonian medications, and while in "on" state, about 1 hour after their regular morning levodopa dose. Assessments included the Unified Parkinson's disease Rating Scale (UPDRS) and a 130 meter, videotaped walk. Three observers independently viewed the videotapes and scored FOG frequency. Parkinsonian features were analyzed by grouping together related UPDRS items. Inter-observer and intra-class reliability between the three observers were evaluated by Pearson and Friedman tests. Pearson correlation coefficients were used to assess the relationships between FOG and other Parkinsonian features. There was a high level of agreement between the three observers (R=0.7). FOG frequency was not correlated with severity of any other Parkinsonian features at "off" and only with speech and writing severity indexes at "on". FOG frequency was significantly decreased by levodopa treatment. This decrement was strongly correlated with improvement of tremor (R=0.80) and speech (R=0.62) indexes. No correlation was found between the response of FOG to levodopa and improvement in rigidity, bradykinesia, or balance indexes. Levodopa treatment decreases FOG frequency in PD patients. FOG is apparently an independent motor symptom of PD, caused by a paroxysmal pathology that is different from that responsible for bradykinesia, rigidity or postural instability. Ongoing research is aimed at understanding the mechanism of this characteristic gait disorder in PD.