Anxiety Increases Freezing of Gait Severity in Individuals With Parkinson Disease

man walking in middle of night
man walking in middle of night
The authors suggest that anxiety should be routinely evaluated in patients with Parkinson disease who experience freezing of gait.

Anxiety is an independent contributor to the severity of gait freezing in Parkinson disease and should be evaluated in patients who have freezing of gait, according to the results of a study published in the Journal of Neuropsychiatry and Clinical Neuroscience.

Nonmotor symptoms such as anxiety and depression are common in those with Parkinson disease, and both symptoms may be present in an individual. Furthermore, anxiety is associated with lack of activity because of fear of falling, which may contribute to gait disorders. Freezing of gait is one of the most disabling features of Parkinson disease. It most often occurs when initiating walking, turning, reaching a destination, or walking through narrow passages. Some have suggested that nonmotor symptoms such as anxiety and cognitive impairment may not only be associated with freezing of gait but may also be involved in its underlying pathophysiology.

Milla Pimenta, MD, of the Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil, and colleagues investigated the association between gait freezing severity and nonmotor symptoms in 78 consecutive participants with idiopathic Parkinson disease at the Movement Disorders Clinic at the State of Bahia Health Attention Center. The authors evaluated Parkinson disease severity with the Unified Parkinson Disease Rating Scale (UPDRS) and the modified Hoehn and Yahr scale. They used Montreal Cognitive Assessment to assess cognition.

Among the 78 individuals, 35% were classified as having freezing of gait. Those with freezing of gait had longer disease duration and greater disease severity on the UPDRS motor and Hoehn and Yahr scale and disability (UPDRS-activities of daily living and Schwab and England scale) than those without freezing of gait. People with freezing of gait also had higher levels of anxiety as measured by the Hospital Anxiety and Depression Scale (HADS)-A and depression as measured by HADS-D. In addition, these patients had lower balance confidence and poorer quality of life as measured by the Parkinson Disease Questionnaire (PDQ-8) (P <0.05). The Freezing of Gait Questionnaire (FOG-Q) showed a small to moderate correlation with both HADS-A and HADS-D. The investigators noted a moderate correlation between the Activities-Specific Balance Confidence scale and FOG-Q, as well as a small correlation with freezing of gait severity (P <.05).

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In the multivariate analysis, disease severity as measured by the Hoehn and Yahr scale accounted for 31% of the FOG-Q severity score variance, whereas the presence of HADS-A ≥8 points increased the explained variance to 38% (P =.010). When the levodopa-equivalent dose was added to this model, the explained variance increased to 42%.

The authors suggest that anxiety should be evaluated routinely in patients with Parkinson disease who experience freezing of gait.


Pimenta M, Moreira D, Nogueira T, et al. Anxiety independently contributes to severity of freezing of gait in people with Parkinson’s disease [published online September 6, 2018]. J Neuropsychiatry Clin Neurosci. doi:10.1176/appi.neuropsych.17090177