Anxiety-related attentional characteristics and their relation to freezing of gait in people with Parkinson's: Cross-validation of the Adapted Gait Specific Attentional Profile (G-SAP)

Abstract

Background: Anxiety often exacerbates freezing of gait (FOG) in people with Parkinson's (PwP). Anxiety-related attentional processes and associated processing inefficiencies, like conscious movement processing (CMP) and ruminations, can substantially impact movement control. However, their impact on FOG remains largely unexplored. Objective: To validate an adapted 10-item (1–5 Likert scale) Gait-Specific Attentional Profile (G-SAP) in PwP and assess if adapted G-SAP-subscales (Physiological Arousal, CMP, Rumination, and Processing Inefficiencies) are associated with self-reported FOG frequency. Methods: We recruited 440 PwP (Mage = 65.5 ± 8.7; 5.8 ± 5.0 years since diagnosis) across the UK. Participants completed the adapted G-SAP and questionnaires on demographics, medical background, and FOG frequency. We assessed adapted G-SAP's internal consistency, structural validity, and subscale scores associations with FOG frequency. Results: The adapted G-SAP showed acceptable internal consistency (α≥0.66) and acceptable/good model fit (comparative fit index = 0.976). Physiological Arousal and CMP subscale scores presented weaker correlations for PwP with FOG (PwP + FOG, r = 0.52) compared to PwP without FOG (PwP-FOG, r = 0.77; p = 0.006). Higher Rumination (OR: 1.323, 95%CI: [1.214–1.440]) and Physiological Arousal (OR: 1.195, 95%CI:[1.037–1.377]) were significantly associated with higher FOG frequency, controlling for age, time since diagnosis and balance/gait problems. Conclusions: The adapted G-SAP is reliable and convenient to measure and identify potentially maladaptive anxiety-related attentional processes that may impact FOG. Results suggest that PwP who experience more worrisome thoughts and greater physiological arousal in daily life are likelier to freeze. Compared to PwP-FOG, for PwP + FOG high physiological arousal was associated with reduced goal-directed focus of attention. Future research will determine if this is a causal risk factor.

Plain language summary: Anxiety can worsen freezing of gait in people with Parkinson's. It often leads to worrisome thoughts and influences how people pay attention to their walking. We think that these changes in attention can substantially influence peoples’ movement – for better or worse. However, there is a lack of research on this topic, and reliable assessment tools are missing. Therefore, we tested if we could assess changes in the thoughts and attention of people with Parkinson's, using a questionnaire (Gait-Specific Attentional Profile (adapted G-SAP)), previously used in older adults without Parkinson's. This questionnaire aims to measure people's perception of their physiological arousal (how anxious they feel), conscious movement (attention they direct to walking), rumination (self-preoccupation with worries about failure and expectations of negative consequences), and thinking efficiency (the ability to focus on different tasks). We also investigated if people who experience freezing show different attentional characteristics compared to people who do not experience freezing. Four-hundred and forty people with Parkinson's filled the adapted G-SAP questionnaire. We confirmed the questionnaire's reliability and found that people who indicated to have more worrisome thoughts and greater physiological arousal also experienced freezing more often. Our findings suggest that people with Parkinson's who experience higher rumination are more likely to experience freezing of gait. The adapted G-SAP represents a short and convenient tool for identifying potentially negative attentional and thinking processes that may increase freezing frequency. With further research to better understand the causes of freezing of gait and their relation to rumination and physiological arousal the adapted G-SAP could be used to monitor and test treatment effect on these constructs in the context of FOG frequency.