Key result
Heart rate significantly increased 4-6 seconds prior to a freezing of gait episode in a high-threat virtual environment, but not in a low-threat environment, linking freezing to elevated anxiety.
Why the study?
It was unknown whether elevated heart rate precedes all subtypes of freezing of gait in Parkinson disease or only episodes driven by anxiety.
Does heart rate increase prior to freezing of gait episodes in Parkinson's disease patients in high-threat environments?
Observational (n=42)
Does heart rate increase prior to freezing of gait episodes in Parkinson's disease patients in high-threat environments?
Increases in heart rate prior to freezing of gait episodes in Parkinson's disease appear linked to elevated anxiety levels, particularly in high-threat environments.
May link anxiety to freezing of gait in high-threat settings; hypothesis-generating and requires prospective trials before clinical consideration.
BACKGROUND: Freezing of gait (FOG) in Parkinson's disease (PD) has been shown to be more frequent in stressful situations, implicating anxiety. Heart rate (HR) has been shown to increase prior to a FOG episode supporting the notion that elevated stress levels may trigger FOG. However, no studies to date have investigated whether elevated HR precedes all subtypes of FOG or only those episodes that are driven by anxiety. OBJECTIVE: The present study sought to investigate whether 1) HR increases prior to FOG episodes in nonspecific environments (Experiment 1), and if 2) HR increases prior to FOG when provoked in high but not low threat environments using a virtual reality paradigm (Experiment 2). METHODS: In Experiment 1, 10 of 19 participants with PD and FOG (PD + FOG) experienced FOG during a series of walking trials. In Experiment 2, 12 of 23 participants with PD + FOG experienced FOG while walking across an elevated and ground level narrow plank in virtual reality. HR was collected throughout the duration of both experiments, while FOG was quantified by experts using video review and tagging. RESULTS: HR significantly increased 2-3 seconds prior to a FOG episode during Experiment 1. In Experiment 2, HR significantly increased 4-6 seconds prior to a FOG episode, specifically while navigating the elevated plank. However, there were no significant increases in HR prior to FOG episodes when participants navigated the ground plank. CONCLUSION: This study extends previous work further demonstrating that increases in HR prior to FOG episodes appear linked to elevated anxiety levels.
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Economou et al. (2020) conducted an observational in Parkinson's disease with freezing of gait (n=42). High threat environment (elevated virtual reality plank) vs. Low threat environment (ground level virtual reality plank) was evaluated on Heart rate changes prior to freezing of gait episodes. Heart rate significantly increased 4-6 seconds prior to a freezing of gait episode in a high-threat virtual environment, but not in a low-threat environment, linking freezing to elevated anxiety.
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