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.