Objective:

To compare experiences and compensatory strategies in freezing of gait (FoG) between individuals with Parkinson’s Disease (PD) plus cognitive impairment (PD+CI) versus PD alone. 

Background:

PD patients with CI, even mild cognitive impairment (MCI), are often excluded from FoG studies, limiting our understanding of the scope of this phenomenon. 

Design/Methods:

In this prospective, single-center, mixed-methods study, we included participants with PD>3 years, MDS-UPDRS subjective and or objective FoG score(s)>2 (mild or worse), and Mini-Cog>0. PD+CI group was defined by Montreal Cognitive Assessment (MoCA)<26. Participants completed the MoCA and a ten-question semi-structured interview regarding FoG impact on daily life and coping strategies. Interviews were manually coded and analyzed using grounded theory for common themes.  

Results:

Eighteen participants comprised each PD+CI and PD group. The median MoCA for the PD+CI group was 21.5 vs. PD 27.5, p<0.0001. PD+CI participants commonly described FoG as a mind-body disconnect with loss of command over their body (27.8%), whereas the PD group often characterized FoG in physical terms as feet stuck or glued to the floor (33.3%). Approaches to overcome FoG unique to the PD+CI group were reactivating one’s attention (11.1%) and incorporating relaxation (11.1%), whereas those distinct to the PD group included visual cues (16.7%) and integrating morning exercise (11.1%). Both groups expressed that FoG was poorly understood by the public. The PD group held unique views in perceiving FoG as a physical liability to others and analogized public misinterpretation of FoG to intoxication. The PD+CI group disclosed and educated others about FoG more than the PD group.

Conclusions:

Both groups viewed public understanding of FoG as limited which discouraged participation in social activities. Educational initiatives around FoG as a part of the constellation of PD symptoms as well as venue arrangements, such as expedited entry and exit for those with FoG, may improve awareness and engagement.