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-PD)
Authors: Rosenblum Uri , Cocks Adam J. , Norris Meriel , Kal Elmar , Young William R. 
Published: March 2024

AbstractBACKGROUNDAnxiety often exacerbates freezing of gait (FOG) in people with Parkinson’s (PwP). Research shows that anxiety-related attentional processes and associated processing inefficiencies, such as conscious movement processing (CMP) and ruminations, can substantially impact movement control. However, the impact of these attentional characteristics on FOG remains largely unexplored.OBJECTIVESTo (i) validate an adapted 10-item (1-5 Likert scale) Gait-Specific Attentional Profile in PwP (G-SAP-PD), and (ii) assess if G-SAP-PD-subscales (Physiological Arousal, CMP, Rumination, and Processing Inefficiencies) are associated with self-reported FOG frequency.METHODSWe recruited 440 PwP (Mage=65.5±8.7; 5.8±5.0 years since diagnosis) across the UK. Participants completed the G-SAP-PD, and questions on demographics, medical background, and FOG frequency (scale of 0: “never freeze” to 4: “every day”). We assessed G-SAP-PD’s internal consistency (alpha), structural validity (confirmatory factor analysis), and subscale scores associations with FOG frequency (ordinal regression).RESULTSThe G-SAP-PD’s showed high internal consistency (α>0.61) and acceptable/good model fit (comparative fit index=0.976). Physiological Arousal and CMP subscale scores were less strongly correlated for PwP with FOG (PwP+FOG, r=.52, p=0.001) compared to (PwP-FOG, r=.79; p=0.001). 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, when controlling for age, time since diagnosis and balance/gait problems.CONCLUSIONSThe G-SAP-PD is a reliable and convenient tool to measure and identifying potentially maladaptive anxiety-related attentional processes that might impact FOG. Our data suggests a relative inability of PwP+FOG to engage in compensatory goal-directed attentional focus. Further study is warranted.Plain Language SummaryAnxiety 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 (G-SAP-PD)), 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 (worrisome thoughts), 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 G-SAP-PD 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 freezing were less able to consciously direct attention to the task at hand (taking a step) when experiencing high physiological arousal. The G-SAP-PD represents a short and convenient tool for identifying potentially negative attentional and thinking processes that may increase freezing frequency. With further research it could be used as a predictive tool and provide possible novel treatments to reduce freezing frequency.