Objective: To study and compare the cognitive, affective and autonomic domains in Parkinson’s disease patients with and without freezing of gait and to correlate with FDG-PET and FDOPA-PET.

Background: Freezing of gait (FOG) is an enigmatic phenomenon. The precise anatomic localisation of freezing is still remains undefined.

Method: This study was conducted in Postgraduate Institute of Medical Education and Research, Chandigarh from July 2021 to December 2022. 30 patients were recruited.15 patients had freezing of gait. Levodopa equivalent dose (LED)  was calculated. Cognitive evaluation was done in the ON phase and it included handedness questionnaire, MMSE, MOCA , FAB and ACE 3. The tremor dominant (TD) vs Postural instability Gait difficulty (PIGD) phenotype was found out. PHQ-9 score was used for depression and GAD-7 scale for anxiety. Autonomic functions was analyzed. FDG-PET and FDOPA-PET was done in both groups. 

Results: The mean age of participants was 59.33 in FOG- and 61.13 in FOG+ group. Mean H and Y in FOG- group was 2.06 and in FOG + group was 2.63.The mean LED in FOG + was 506.80 and in FOG–was 888.60.13 out of 15 patients (86.7%) were found to be PIGD phenotype. 12 out of the 15 patients in FOG+ group had freezing which was responsive to Levodopa. In cognitive evaluation the mean FAB score was 13.87 in FOG – group and 13.40 in FOG + group. ACE showed a mean ACE total score 83.60 in FOG- group and 81.53 in FOG + group.PHQ-9 scores and GAD-7 scores and the autonomic scores did not differ significantly between the 2 groups. FDOPA-PET scan showed patients in FOG + group had symmetrical loss of basal ganglia uptake compared to non-freezing group. Basal ganglia hypometabolism was looked for and compared between the 2 groups.Compared to FOG- group, FOG + group showed more pronounced hypometabolism in the basal ganglia region.

Conclusion: Patients with FOG had a higher mean LED compared to patients without FOG. Majority of the patients with freezing of gait had PIGD phenotype of Parkinson disease.No significant difference in cognitive function tests between the 2 groups. FDOPA-PET showed more severe and bilateral involvement in freezer’s compared to non-freezer group. FDG-PET showed multiple areas of hypometabolism involving bilateral fronto-parietal and temporal regions in both groups.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparison-of-cognitive-affective-and-autonomic-functions-in-parkinsons-disease-patients-with-and-without-freezing-of-gait-and-its-correlation-with-pet-ct/