Poor sleep quality is associated with cognitive, mobility, and anxiety disability that underlie freezing of gait in Parkinson's disease

Author(s)

de Almeida, Filipe Oliveira ; Ugrinowitsch, Carlos ; Brito, Leandro C. ; Milliato, Angelo ; Marquesini, Raquel ; Moreira-Neto, Acacio ; Barbosa, Egberto Reis ; Horak, Fay B. ; Mancini, Martina ; Silva-Batista, Carla

• Document type: Journal article
• Source: GAIT & POSTURE; v. 85, p. 7-pg., 2021-02-09.

Abstract

Background: Individuals with Parkinson's disease (PD) who report freezing of gait (FOG) have poorer sleep quality than those without FOG. Cognitive, anxiety, and mobility disability are components of the FOG phenotype, however, no study has investigated if poor sleep quality is associated with all three components that underlie FOG in PD. Research question: Are there associations among sleep quality and all three components of the FOG phenotype? Methods: Forty and 39 individuals with and without FOG (PD + FOG and PD-FOG), respectively, and 31 agematched healthy controls (HC) participated in this study. Self-reported FOG (new-FOG questionnaire-NFOGQ), sleep quality (Pittsburgh Sleep Quality Index-PSQI), cognitive function (Montreal Cognitive AssessmentMoCA), anxiety (subscale from Hospital Anxiety and Depression Scale-HADS-A), and mobility (timed-up-andgo test-TUG) were assessed. Results and Significance: PSQI scores were correlated with the scores of NFOGQ, MoCA, HADS-A, and TUG time in PD + FOG (P <= 0.0038). The multiple regression analysis identified the PSQI scores as the only predictor of the variance of the NFOGQ scores (R-2 = 0.46, P < .0001). The variance in the PSQI scores were explained (69 %) by MoCA scores, NFOGQ scores, TUG time, and HADS-A scores (P <= 0.05). Although PD + FOG had a higher disease severity compared to PD-FOG (P < 0.001), disease severity did not enter in the regression model to explain PSQI scores and NFOGQ scores. We also observed associations of PSQI scores with the MoCA scores and TUG time for HC (P <= 0.0038), whereas there was no association between PSQI scores and any variable in PD-FOG (P > 0.05). Finally, PD + FOG presented worse scores of PSQI, MoCA, HADS-A, and TUG time than PD-FOG and HC (P < 0.05). Thus, poor sleep quality is associated with FOG and all three components that underlie FOG, regardless of the disease severity. Therefore, treatments useful to decrease FOG should be targeted to ameliorate sleep quality, cognition, anxiety, and mobility. (AU)

• FAPESP's process: 13/04970-4 - Influence of functional and strength training on neuromuscular adaptations, functionality and quality of life in elderly with Parkinson's Disease
• Grantee: Carla da Silva Batista
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)
• FAPESP's process: 16/13115-9 - Effects of resistance training with instability on clinical outcomes, spinal mechanisms, and brain metrics in individuals with freezing of gait in Parkinson's disease
• Grantee: Carla da Silva Batista
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• FAPESP's process: 18/16909-1 - Effects of resistance training with instability on clinical outcomes, spinal mechanisms, and brain metrics in individuals with freezing of gait in Parkinson's disease
• Grantee: Carla da Silva Batista
• Support Opportunities: Scholarships abroad - Research Internship - Post-doctor