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Article(id=1322211003786445761, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322210968248107603, articleNumber=null, orderNo=null, doi=10.16016/j.2097-0927.202412078, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1734278400000, receivedDateStr=2024-12-16, revisedDate=1736438400000, revisedDateStr=2025-01-10, acceptedDate=null, acceptedDateStr=null, onlineDate=1793169268794, onlineDateStr=2026-10-28, pubDate=1747238400000, pubDateStr=2025-05-15, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793169268794, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793169268794, creator=13701087609, updateTime=1793169268794, updator=13701087609, issue=Issue{id=1322210968248107603, tenantId=1146029695717560320, journalId=1319373162502258839, year='2025', volume='47', issue='9', pageStart='893', pageEnd='1028', issueExtLink='null', onlineDate='null', pubDate='1747238400000', pubDateStr='2025-05-15', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793169260321, creator='13701087609', updateTime=1793325292291, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322865413818536367, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322210968248107603, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322865413818536368, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322210968248107603, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1018, endPage=1028, ext={EN=ArticleExt(id=1322211003958412226, articleId=1322211003786445761, tenantId=1146029695717560320, journalId=1319373162502258839, language=EN, title=Differences in motor function and psychological factors across phenotypic patterns of freezing of gait in Parkinson’s disease, columnId=1320435226828980311, journalTitle=Journal of Army Medical University, columnName=Medical Psychology, runingTitle=null, highlight=null, articleAbstract=
Objective‍

To investigate the characteristic changes in motor function and psychological factors among Parkinson’s disease (PD) patients with different phenotypic patterns of freezing of gait (FOG), and to explore the trends in phenotypic heterogeneity of these features.

Methods‍

A cross-sectional study was conducted on 17 PD patients without FOG (PD-NFOG) and 25 PD patients with FOG (PD-FOG) [including 13 cases of trembling-in-place (TP) and 12 cases of shuffling-with-small-steps (SS)]. Another 28 demographically matched (age, gender, education level and others) healthy individuals were recruited from community and served as healthy controls (HC). Motor function was assessed using quantitative gait analysis and clinical scales, including the unified Parkinson’s disease rating scale part Ⅲ (UPDRS-Ⅲ) and H&Y staging. Psychological evaluations were carried out with Hospital Anxiety and Depression Scale (HADS-A/HADS-D), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Snaith-Hamilton Pleasure Scale (SHAPS), Reading the Mind in the Eyes Test (RMET), Montreal Cognitive Assessment (MoCA), and digital symbol substitution test (DSST).

Results‍

① There were significant differences between the PD-FOG and PD-NFOG groups in terms of motor parameters (stride width, length, height and cadence) and cognitive function (MoCA) score (P<0.05). The largest effect sizes were found for cognitive function scores of RMET [η²=0.716 (95%CI:0.611~0.761), P<0.05], DSST [η²=0.667 (95%CI:0.553~0.744), P<0.05], and MoCA [η²=0.597 (95%CI:0.425~0.750), P<0.05], all of which were classified as medium effect sizes. ② Associative characteristics of motor and psychological factors in the PD-FOG group: H&Y stage was positively correlated with HADS-A [r=0.470 (95%CI:0.080~0.735), P=0.018] and HADS-D [r=0.560 (95%CI:0.199~0.787), P=0.004], while the total score of UPDRS-Ⅲ was negatively correlated with DSST [r=-0.574 (95%CI: -0.794~-0.219), P=0.003]. ③Subgroup analysis revealed significant differences (P<0.05) between the TP and SS patterns in motor parameters (stride length and cadence). Moderate effect sizes were observed for HADS-A [δ=0.752 (95%CI: -0.070~1.558), P=0.072], SHAPS [δ=0.512 (95%CI: -0.291~1.305), P=0.132] and HADS-D [δ=0.481 (95%CI: -0.321~1.273), P=0.253], with mean increase by 39.0%, 8.3%, and 24.5%, respectively, in the TP subgroups when compared to the SS subgroups.

Conclusion‍

PD-FOG patients exhibit characteristic changes in motor function and psychological factors. Cognitive impairment in PD patients may serve as a characteristic marker for FOG progression. Additionally, psychological features in PD-FOG patients with different motor phenotypes show trends of phenotypic heterogeneity.

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目的

探究帕金森病（Parkinson’s disease，PD）伴冻结步态（freezing of gait，FOG）患者的运动功能与心理因素的特征性改变，并探索这些特征的表型异质性趋势。

方法

本研究为横断面研究，纳入2023年3月至2024年3月在陆军军医大学第一附属医院神经内科就诊的患者，其中PD不伴FOG（Parkinson’s disease without freezing of gait，PD-NFOG）患者17例，PD伴FOG（Parkinson’s disease with freezing of gait，PD-FOG）患者25例，PD-FOG患者根据步态特征分为原地震颤型（trembling in place，TP）13例和小步伐拖足行进型（shuffling with small steps，SS）12例，同时通过社区招募纳入年龄、性别和受教育程度等人口学信息相匹配的正常对照（healthy control，HC）组28例。采用定量步态参数测定系统和量表，对受试者的运动功能进行评估，包括帕金森病统一得分量表中的运动评分量表（unified Parkinson’s disease rating scalem Ⅲ，UPDRS Ⅲ）、H&Y分级等；采用心理量表对受试者的情绪状态、认知功能及生活质量进行评估，包括医院焦虑量表（Hospital Anxiety and Depression Scale-Anxiety，HADS-A）、医院抑郁量表（Hospital Anxiety and Depression Scale-Depression，HADS-D）、广泛性焦虑障碍量表（Generalized Anxiety Disorder-7，GAD-7）、抑郁症筛查量表（Patient Health Questionnaire-9，PHQ-9）、快感缺失量表（Snaith-Hamilton Pleasure Scale，SHAPS）、眼神读心测验量表（Reading the Mind in the Eyes Test，RMET）、蒙特利尔认知评估量表（Montreal Cognitive Assessment，MoCA）、数字符号替换测试量表（Digital Symbol Substitution Test，DSST）等。

结果

①PD-FOG和PD-NFOG组在运动功能参数（步宽、步幅、步高、步频等）和认知功能评分（MoCA得分）上存在显著差异（P<0.05）；组间在RMET［η²=0.716（95%CI：0.611~0.761），P<0.05］、DSST［η²=0.667（95%CI：0.553~0.744），P<0.05］、MoCA［η²=0.597（95%CI：0.425~0.750），P<0.05］3项认知功能评分上显示了最大的效应量，均为中等效应量；②PD-FOG组运动与心理的关联特征：H&Y分级与HADS-A［r=0.470（95%CI：0.080~0.735），P=0.018］、HADS-D［r=0.560（95%CI：0.199~0.787），P=0.004］得分呈现正相关；UPDRS Ⅲ总分与DSST［r=-0.574（95%CI：-0.794~-0.219），P=0.003］得分呈现负相关；③PD-FOG亚组分析：TP组和SS组不仅在运动功能参数上（步幅、步频）存在显著差异（P<0.05），而且在HADS-A［δ=0.752（95%CI：-0.070~1.558），P=0.072］、SHAPS［δ=0.512（95%CI：-0.291~1.305），P=0.132］和HADS-D［δ=0.481（95%CI：-0.321~1.273），P=0.253］3项心理量表得分上显示了中等效应量。相对于SS组，TP组这3项指标的平均值分别增加了39.0%、8.3%和24.5%。

结论

PD-FOG患者的运动功能与心理因素存在特征性改变，PD患者的认知损伤可能是FOG进展的特征性标志，不同运动表型PD-FOG患者的心理特征存在表型异质性趋势。

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黄河清，E-mail：
HUANG Heqing，E-mail：
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Mov Disord，2004，19（8）：871-884., articleTitle=Falls and freezing of gait in Parkinson’s disease：a review of two interconnected，episodic phenomena, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322211007200609233, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, xref=1, ext=[AuthorCompanyExt(id=1322211007208997842, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, companyId=1322211007200609233, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of Medical Psychology，First Affiliated Hospital，Army Medical University （Third Military Medical University），Chongqing，China), AuthorCompanyExt(id=1322211007217386451, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, companyId=1322211007200609233, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1陆军军医大学（第三军医大学）第一附属医院医学心理科，重庆)])], figs=[ArticleFig(id=1322211009239041005, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, language=EN, label=null, caption=null, figureFileSmall=nTqtmTp6E//SPqoQYUGYaw==, figureFileBig=1IFVOK/B7hl6shFhIByYMQ==, tableContent=null), ArticleFig(id=1322211009314538478, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, language=CN, label=图1, caption=各组间运动功能参数的显著差异指标, figureFileSmall=nTqtmTp6E//SPqoQYUGYaw==, figureFileBig=1IFVOK/B7hl6shFhIByYMQ==, tableContent=null), ArticleFig(id=1322211009503282159, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, language=EN, label=null, caption=null, figureFileSmall=+HeianJaPMLjUh87Kfh9+A==, figureFileBig=cILAqWZcBw+gsBuCMPVo/A==, tableContent=null), ArticleFig(id=1322211009562002416, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, language=CN, label=图2, caption=各组间心理测评得分的显著差异指标, figureFileSmall=+HeianJaPMLjUh87Kfh9+A==, figureFileBig=cILAqWZcBw+gsBuCMPVo/A==, tableContent=null), ArticleFig(id=1322211009629111281, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, language=EN, label=null, caption=null, figureFileSmall=sBOAI9xb22ryHgCZHkvIeQ==, figureFileBig=kBEVbfVrrF72dryAGR/0jg==, tableContent=null), ArticleFig(id=1322211011290055666, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, language=CN, label=图3, caption=各组显著差异指标的效应量比较, figureFileSmall=sBOAI9xb22ryHgCZHkvIeQ==, figureFileBig=kBEVbfVrrF72dryAGR/0jg==, tableContent=null), ArticleFig(id=1322211011373941747, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, language=EN, label=null, caption=null, figureFileSmall=dN8AUqaY1p/BLkSO7lubTw==, figureFileBig=8IfQ8KAkWTPQ5qfrD9F06w==, tableContent=null), ArticleFig(id=1322211011441050612, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, language=CN, label=图4, caption=PD-FOG组运动功能与心理因素的关联特征, figureFileSmall=dN8AUqaY1p/BLkSO7lubTw==, figureFileBig=8IfQ8KAkWTPQ5qfrD9F06w==, tableContent=null), ArticleFig(id=1322211011499770869, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, language=EN, label=null, caption=null, figureFileSmall=q4wTfmMu+boKHC2rcbRGtw==, figureFileBig=B0Rbo0J1ACFxDSF6tn1+bA==, tableContent=null), ArticleFig(id=1322211011558491126, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, language=CN, label=图5, caption=PD-FOG表型间运动功能参数的差异性分析

A：TP组和SS组的PD步态分析-步幅箱形图；B：TP组和SS组的PD步态分析-步频箱形图

, figureFileSmall=q4wTfmMu+boKHC2rcbRGtw==, figureFileBig=B0Rbo0J1ACFxDSF6tn1+bA==, tableContent=null), ArticleFig(id=1322211011617211383, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, language=EN, label=null, caption=null, figureFileSmall=7GY8QLKM1w7toDTEedyHnQ==, figureFileBig=HWCS9TS6R4XB5cpU2ryppg==, tableContent=null), ArticleFig(id=1322211011705291768, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, language=CN, label=图6, caption=PD-FOG表型间心理测评得分的效应量比较, figureFileSmall=7GY8QLKM1w7toDTEedyHnQ==, figureFileBig=HWCS9TS6R4XB5cpU2ryppg==, tableContent=null), ArticleFig(id=1322211011784983545, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
指标PD-FOG组（n=25）PD-NFOG组（n=17）HC组（n=28）P
性别0.433
男性15713
女性101015
年龄/岁66.480±4.21464.235±6.00664.143±4.1250.150
受教育年限/年9.760±2.4889.118±2.9139.571±1.5970.482
BMI/（kg/m²）26.567±4.77425.556±3.27624.503±1.2090.209
吸烟0.207
是227
否231521
饮酒0.370
是114
否241624
病程/年8.640±5.5246.150±4.050-0.088
起病侧-0.474
左98
右169
H&Y分级2.520±0.4892.324±0.393-0.185
UPDRS Ⅲ总分/分49.720±12.73937.235±13.836-<0.050
LEDD/mg1 454.118±702.0421 317.610±650.776-0.481
), ArticleFig(id=1322211011856286714, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, language=CN, label=表1, caption=

各组的人口学信息和疾病特征信息（x¯±s，例）

, figureFileSmall=null, figureFileBig=null, tableContent=
指标PD-FOG组（n=25）PD-NFOG组（n=17）HC组（n=28）P
性别0.433
男性15713
女性101015
年龄/岁66.480±4.21464.235±6.00664.143±4.1250.150
受教育年限/年9.760±2.4889.118±2.9139.571±1.5970.482
BMI/（kg/m²）26.567±4.77425.556±3.27624.503±1.2090.209
吸烟0.207
是227
否231521
饮酒0.370
是114
否241624
病程/年8.640±5.5246.150±4.050-0.088
起病侧-0.474
左98
右169
H&Y分级2.520±0.4892.324±0.393-0.185
UPDRS Ⅲ总分/分49.720±12.73937.235±13.836-<0.050
LEDD/mg1 454.118±702.0421 317.610±650.776-0.481
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变量TP型（n=13）SS型（n=12）P
性别0.428
男性96
女性46
年龄/岁65.154±3.69367.917±4.4200.063
受教育年限/年10.077±2.6609.417±2.3530.517
BMI/（kg/m²）24.505±3.08328.801±5.3750.082
吸烟1.000
是11
否1211
饮酒1.000
是10
否1212
病程/年9.120±6.9508.130±3.6500.978
起病侧0.226
左36
右106
H&Y分级2.423±0.4002.625±0.5690.403
UPDRS Ⅲ总分/分48.154±12.71451.417±13.1040.479
LEDD/mg1 500.876±826.6521 403.463±569.6290.514
), ArticleFig(id=1322211012036641788, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, language=CN, label=表2, caption=

不同表型PD-FOG患者人口学信息和疾病特征信息的比较（x¯±s，例）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量TP型（n=13）SS型（n=12）P
性别0.428
男性96
女性46
年龄/岁65.154±3.69367.917±4.4200.063
受教育年限/年10.077±2.6609.417±2.3530.517
BMI/（kg/m²）24.505±3.08328.801±5.3750.082
吸烟1.000
是11
否1211
饮酒1.000
是10
否1212
病程/年9.120±6.9508.130±3.6500.978
起病侧0.226
左36
右106
H&Y分级2.423±0.4002.625±0.5690.403
UPDRS Ⅲ总分/分48.154±12.71451.417±13.1040.479
LEDD/mg1 500.876±826.6521 403.463±569.6290.514
), ArticleFig(id=1322211012103750653, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
变量TP型（n=13）SS型（n=12）Pδ
GAD-77.308±4.7505.833±5.2890.4720.294
HADS-A10.077±3.8837.250±3.6210.0720.752
HADS-D8.923±2.7837.167±4.4070.2530.481
PHQ-98.769±5.0366.667±4.6380.2880.434
SHAPS26.615±3.92724.583±4.0100.1320.512
RMET16.923±5.51515.417±5.4850.5010.274
MoCA21.000±5.52321.000±3.9541.0000.000
DSST23.538±5.60721.500±11.4380.5840.229
PDQ-3950.231±21.13150.000±26.8700.9810.100
), ArticleFig(id=1322211012196025342, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322211003786445761, language=CN, label=表3, caption=

不同表型PD-FOG心理测评得分的差异性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量TP型（n=13）SS型（n=12）Pδ
GAD-77.308±4.7505.833±5.2890.4720.294
HADS-A10.077±3.8837.250±3.6210.0720.752
HADS-D8.923±2.7837.167±4.4070.2530.481
PHQ-98.769±5.0366.667±4.6380.2880.434
SHAPS26.615±3.92724.583±4.0100.1320.512
RMET16.923±5.51515.417±5.4850.5010.274
MoCA21.000±5.52321.000±3.9541.0000.000
DSST23.538±5.60721.500±11.4380.5840.229
PDQ-3950.231±21.13150.000±26.8700.9810.100
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帕金森病不同表型冻结步态的运动功能与心理因素的差异性研究
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常淞 , 崔啸 , 黄河清
陆军军医大学学报 | 医学心理学 2025,47(9): 1018-1028
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陆军军医大学学报 |医学心理学 2025 , 47 (9) : 1018 -1028
帕金森病不同表型冻结步态的运动功能与心理因素的差异性研究
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常淞, 崔啸, 黄河清
作者信息
  • 1陆军军医大学（第三军医大学）第一附属医院医学心理科，重庆
通讯作者:
黄河清，E-mail：
HUANG Heqing，E-mail：
Differences in motor function and psychological factors across phenotypic patterns of freezing of gait in Parkinson’s disease
Song CHANG, Xiao CUI, Heqing HUANG
Affiliations
  • 1Department of Medical Psychology，First Affiliated Hospital，Army Medical University （Third Military Medical University），Chongqing，China
出版时间: 2025-05-15 doi: 10.16016/j.2097-0927.202412078
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摘要
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目的

探究帕金森病（Parkinson’s disease，PD）伴冻结步态（freezing of gait，FOG）患者的运动功能与心理因素的特征性改变，并探索这些特征的表型异质性趋势。

方法

本研究为横断面研究，纳入2023年3月至2024年3月在陆军军医大学第一附属医院神经内科就诊的患者，其中PD不伴FOG（Parkinson’s disease without freezing of gait，PD-NFOG）患者17例，PD伴FOG（Parkinson’s disease with freezing of gait，PD-FOG）患者25例，PD-FOG患者根据步态特征分为原地震颤型（trembling in place，TP）13例和小步伐拖足行进型（shuffling with small steps，SS）12例，同时通过社区招募纳入年龄、性别和受教育程度等人口学信息相匹配的正常对照（healthy control，HC）组28例。采用定量步态参数测定系统和量表，对受试者的运动功能进行评估，包括帕金森病统一得分量表中的运动评分量表（unified Parkinson’s disease rating scalem Ⅲ，UPDRS Ⅲ）、H&Y分级等；采用心理量表对受试者的情绪状态、认知功能及生活质量进行评估，包括医院焦虑量表（Hospital Anxiety and Depression Scale-Anxiety，HADS-A）、医院抑郁量表（Hospital Anxiety and Depression Scale-Depression，HADS-D）、广泛性焦虑障碍量表（Generalized Anxiety Disorder-7，GAD-7）、抑郁症筛查量表（Patient Health Questionnaire-9，PHQ-9）、快感缺失量表（Snaith-Hamilton Pleasure Scale，SHAPS）、眼神读心测验量表（Reading the Mind in the Eyes Test，RMET）、蒙特利尔认知评估量表（Montreal Cognitive Assessment，MoCA）、数字符号替换测试量表（Digital Symbol Substitution Test，DSST）等。

结果

①PD-FOG和PD-NFOG组在运动功能参数（步宽、步幅、步高、步频等）和认知功能评分（MoCA得分）上存在显著差异（P<0.05）；组间在RMET［η²=0.716（95%CI：0.611~0.761），P<0.05］、DSST［η²=0.667（95%CI：0.553~0.744），P<0.05］、MoCA［η²=0.597（95%CI：0.425~0.750），P<0.05］3项认知功能评分上显示了最大的效应量，均为中等效应量；②PD-FOG组运动与心理的关联特征：H&Y分级与HADS-A［r=0.470（95%CI：0.080~0.735），P=0.018］、HADS-D［r=0.560（95%CI：0.199~0.787），P=0.004］得分呈现正相关；UPDRS Ⅲ总分与DSST［r=-0.574（95%CI：-0.794~-0.219），P=0.003］得分呈现负相关；③PD-FOG亚组分析：TP组和SS组不仅在运动功能参数上（步幅、步频）存在显著差异（P<0.05），而且在HADS-A［δ=0.752（95%CI：-0.070~1.558），P=0.072］、SHAPS［δ=0.512（95%CI：-0.291~1.305），P=0.132］和HADS-D［δ=0.481（95%CI：-0.321~1.273），P=0.253］3项心理量表得分上显示了中等效应量。相对于SS组，TP组这3项指标的平均值分别增加了39.0%、8.3%和24.5%。

结论

PD-FOG患者的运动功能与心理因素存在特征性改变，PD患者的认知损伤可能是FOG进展的特征性标志，不同运动表型PD-FOG患者的心理特征存在表型异质性趋势。

冻结步态  /  帕金森病  /  心理因素  /  认知功能  /  运动功能
Objective‍

To investigate the characteristic changes in motor function and psychological factors among Parkinson’s disease (PD) patients with different phenotypic patterns of freezing of gait (FOG), and to explore the trends in phenotypic heterogeneity of these features.

Methods‍

A cross-sectional study was conducted on 17 PD patients without FOG (PD-NFOG) and 25 PD patients with FOG (PD-FOG) [including 13 cases of trembling-in-place (TP) and 12 cases of shuffling-with-small-steps (SS)]. Another 28 demographically matched (age, gender, education level and others) healthy individuals were recruited from community and served as healthy controls (HC). Motor function was assessed using quantitative gait analysis and clinical scales, including the unified Parkinson’s disease rating scale part Ⅲ (UPDRS-Ⅲ) and H&Y staging. Psychological evaluations were carried out with Hospital Anxiety and Depression Scale (HADS-A/HADS-D), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Snaith-Hamilton Pleasure Scale (SHAPS), Reading the Mind in the Eyes Test (RMET), Montreal Cognitive Assessment (MoCA), and digital symbol substitution test (DSST).

Results‍

① There were significant differences between the PD-FOG and PD-NFOG groups in terms of motor parameters (stride width, length, height and cadence) and cognitive function (MoCA) score (P<0.05). The largest effect sizes were found for cognitive function scores of RMET [η²=0.716 (95%CI:0.611~0.761), P<0.05], DSST [η²=0.667 (95%CI:0.553~0.744), P<0.05], and MoCA [η²=0.597 (95%CI:0.425~0.750), P<0.05], all of which were classified as medium effect sizes. ② Associative characteristics of motor and psychological factors in the PD-FOG group: H&Y stage was positively correlated with HADS-A [r=0.470 (95%CI:0.080~0.735), P=0.018] and HADS-D [r=0.560 (95%CI:0.199~0.787), P=0.004], while the total score of UPDRS-Ⅲ was negatively correlated with DSST [r=-0.574 (95%CI: -0.794~-0.219), P=0.003]. ③Subgroup analysis revealed significant differences (P<0.05) between the TP and SS patterns in motor parameters (stride length and cadence). Moderate effect sizes were observed for HADS-A [δ=0.752 (95%CI: -0.070~1.558), P=0.072], SHAPS [δ=0.512 (95%CI: -0.291~1.305), P=0.132] and HADS-D [δ=0.481 (95%CI: -0.321~1.273), P=0.253], with mean increase by 39.0%, 8.3%, and 24.5%, respectively, in the TP subgroups when compared to the SS subgroups.

Conclusion‍

PD-FOG patients exhibit characteristic changes in motor function and psychological factors. Cognitive impairment in PD patients may serve as a characteristic marker for FOG progression. Additionally, psychological features in PD-FOG patients with different motor phenotypes show trends of phenotypic heterogeneity.

freezing of gait  /  Parkinson’s disease  /  psychological factor  /  cognitive function  /  motor function
常淞, 崔啸, 黄河清. 帕金森病不同表型冻结步态的运动功能与心理因素的差异性研究. 陆军军医大学学报, 2025 , 47 (9) : 1018 -1028 . DOI: 10.16016/j.2097-0927.202412078
Song CHANG, Xiao CUI, Heqing HUANG. Differences in motor function and psychological factors across phenotypic patterns of freezing of gait in Parkinson’s disease[J]. Journal of Army Medical University, 2025 , 47 (9) : 1018 -1028 . DOI: 10.16016/j.2097-0927.202412078
正文
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帕金森病（Parkinson’s disease，PD）是一种以运动障碍为核心的神经退行性疾病，其中冻结步态（freezing of gait，FOG）作为最具致残性的并发症之一［1-2］，显著增加PD患者的跌倒风险并降低生活质量［3］。FOG临床表现具有高度异质性，根据步态特征可分为原地震颤型（trembling in place，TP）、小步伐拖足行进型（shuffling with small steps，SS）和完全运动不能型［4］。研究表明，FOG各表型存在不同的网络特征和功能异常［5-8］，但其病理机制尚未完全阐明［9］。值得注意的是，FOG的发作常与时间压力、双重任务、黑暗环境或者狭窄空间等情境相关，提示情绪与认知等心理因素可能通过影响运动控制网络参与其病理过程［10］。然而，现有研究多聚焦于运动功能障碍本身，对心理因素与不同表型FOG的关联特征仍缺乏系统性探索，制约了针对性干预策略的制定［11］。
近年来，神经影像学证据表明，焦虑、抑郁及认知损伤可能通过边缘-认知-运动系统的网络冲突诱发或加剧FOG［9，12］。但多数研究并未考虑FOG的高度异质性，未能揭示不同表型FOG患者的心理特征。此外，传统的运动功能评估方法难以精准识别和定量评估步态参数的动态变化，而基于人工智能的步态分析技术的发展提供了新的可能。因此，探索不同表型FOG的运动功能与心理特征，不仅有助于阐明其共性与差异的神经机制，更能为临床制定表型导向的个体化干预方案提供理论依据。
本研究为横断面研究，创新地整合了基于人工智能的定量步态参数测定与多维度心理测评，探索PD-FOG患者的运动功能及情绪、认知等心理因素的特征性改变，以及这些特征的表型异质性趋势，旨在为制定表型导向的心理干预策略提供客观依据。
1　资料与方法
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1.1　研究对象
根据既往基于视频评估的步态参数研究和步态相关样本量合理性研究［13-14］，估算本研究的样本量为每组20例。最终，本研究纳入2023年3月至2024年3月在陆军军医大学第一附属医院神经内科就诊的PD-FOG（Parkinson’s disease with freezing of gait，PD-FOG）患者25例、PD不伴FOG（Parkinson’s disease without freezing of gait，PD-NFOG）患者17例，其中PD-FOG患者根据步态表现形式分为TP组13例和SS组12例，同时通过社区招募纳入年龄、性别和受教育程度等人口学信息相匹配的正常对照（healthy control，HC）组28例，所有入组受试者为右利手。
PD-FOG患者由1~2名PD专病门诊专家按照诊断标准进行筛选与评估。纳入标准：①年龄18~75岁；②符合国际帕金森病与运动障碍学会（International Parkinson and Movement Disorder Society，MDS）诊断标准的PD，H&Y分级1~4级［15］；③病史采集和体格检查中发现FOG，同时冻结步态问卷（freezing of gait questionnaire，FOG-Q）第3项目得分≥1分［11］，则诊断为FOG；④能够在没有支撑的情况下独立行走>30 m，并且能够完成转动180°的动作；⑤无显著认知功能损害且具有正常沟通理解能力。排除标准：①合并其他严重精神、神经疾病，严重脑外伤、脑结构异常；②接受过脑深部刺激手术、心脏起搏器植入手术，或存在其他金属植入物等；③合并可能影响步态的局部或系统性疾病（如骨关节炎、肌力障碍等）；④存在抗精神病用药史。FOG表型分类：①TP型：双下肢颤抖，频率为3~8 Hz，无法进行有效的迈步；②SS型：足底拖曳明显，步幅进行性缩小，步频增快［4］。PD-NFOG组的纳入标准同上述纳入标准中的①、②、④、⑤，排除标准同上；HC组的纳入标准同上述纳入标准中的①、④、⑤，排除标准同上。
受试者入组前需要稳定治疗方案1个月以上。受试者需在各项检查前保证至少12 h停用多巴胺能药物。排除饮酒、过度劳累等任何可能影响步态的行为因素。本研究经陆军军医大学第一附属医院伦理委员会审核通过［（A）KY2023081］。本研究已在中国临床试验注册中心注册（ChiCTR2400080727）。所有受试者入组前签署知情同意书。
1.2　研究工具与方法
1.2.1　人口学信息和疾病特征信息
人口学信息包括年龄、性别、受教育年限、体质指数（body mass index，BMI）、吸烟和饮酒情况，疾病特征信息包括病程、起病侧、帕金森病统一得分量表中的运动评分量表（unified Parkinson’s disease rating scalem Ⅲ，UPDRS Ⅲ）总分、H&Y分级、服用的每日左旋多巴等效剂量（levodopa equivalent daily dose，LEDD）等。
1.2.2　运动功能评估
运动功能评估包括UPDRS Ⅲ总分和H&Y分级测定、FOG-Q量表评估以及定量步态参数测定。上述所有项目的施测评估由PD专病门诊专家完成，并且使用ReadyGo™运动功能定量评价系统（北京信息技术有限公司中科睿医）全程记录评估影像、计算步态参数。
1.2.2.1　UPDRS Ⅲ总分
UPDRS是评估PD患者整体运动和非运动功能应用最广泛的临床量表，反映PD患者的功能障碍和疾病严重程度。该量表分为4个部分，其中，UPDRS Ⅲ提供运动功能的综合评估，量表包括18个项目，采用Likert 5级（0~4分）评分，0~4分分别表示正常、轻微、轻度、中度和重度［16-17］。
1.2.2.2　H&Y分级
H&Y分级用于临床医生监测PD患者的疾病进展和治疗效果。根据疾病是否累及双侧肢体或影响中轴运动、是否存在平衡和姿势障碍、是否可以独立行走等，评估病情的严重程度，H&Y分级包括0~5级，分级越高，表示疾病越严重［18］。
1.2.2.3　FOG-Q量表
该量表通过评估受试者近1个月内FOG的主观体验，量化FOG的严重程度及其对日常生活的功能损害［18］。FOG-Q包含6个项目，采用Likert 5级（0~4分）评分，评分越高提示FOG症状越严重。该量表具有较高的内部和重测可靠性［19］。
1.2.2.4　定量步态参数测定
ReadyGo™系统的步态测定程序，对受试者全身三维姿势和动作的关键运动节点进行自动识别和实时追踪，通过人工智能深度学习算法，定量分析受试者的步态参数。该系统测量精度通过了专业资质验证，运动参数与真实值误差<5%［20］。受试者被要求以日常的步行速度和方式在3 m的步道上完成3个来回的路程（含转弯），共18 m。系统定量分析受试者的21个代表性步态特征参数：双侧的步频、步幅、步高、摆动相、站立相、双支撑相、摆臂幅度、跨步速度、摆动速度，以及步宽、步速和转身时间。
1.2.3　心理测评
1.2.3.1　广泛性焦虑障碍量表（Generalized Anxiety Disorder-7，GAD-7）
该量表用于评估受试者在最近2周内焦虑症状的发生频率和严重程度。该筛查量表包含7个项目，采用Likert 4级（0~3分）评分，总分21分，分数越高，表明受试者的焦虑程度越高。国内外研究均显示GAD-7具有较高的信效度［21-23］。本研究中量表的Cronbach’ s α系数为0.943。
1.2.3.2　医院焦虑抑郁量表（Hospital Anxiety and Depression Scale，HADS）
该量表用于筛查医院患者最近1个月内的焦虑和抑郁症状。量表包含14个项目，分为医院焦虑量表（Hospital Anxiety and Depression Scale-Anxiety，HADS-A）和医院抑郁量表（Hospital Anxiety and Depression Scale-Depression，HADS-D）2个亚量表，每个亚量表7个项目，采用Likert 4级（0~3分）评分，总分21分，用于评估症状的频率和强度，分数越高，表明受试者的焦虑抑郁程度越高。国内外研究均显示HADS具有较高的信效度［24-26］。本研究中量表的Cronbach’ s α系数为0.898。
1.2.3.3　抑郁症筛查量表（Patient Health Questionnaire-9，PHQ-9）
该量表用于检测和评估受试者最近2周内抑郁症状的严重程度。量表包含9个项目，采用Likert 4级（0~3分）评分，总分21分，分数越高，表明抑郁程度越严重。研究显示PHQ-9具有较高的信效度［27］。本研究中量表的Cronbach’ s α系数为0.908。
1.2.3.4　快感缺失量表（Snaith-Hamilton Pleasure Scale，SHAPS）
该量表是用于评估个体体验快感能力的自评量表。该量表包含14个项目，每个项目都描述了与快感体验相关的情况或活动。受试者根据自己在过去几天内的感受，采用Likert 4级（0~3分）评分，总分42分，分数越高，表示受试者的快感缺失越严重。研究显示SHAPS具有较高的信效度［28］。本研究中量表的Cronbach’ s α系数为0.899。
1.2.3.5　眼神读心测验量表（Reading the Mind in the Eyes Test，RMET）
该量表旨在评估个体通过观察他人眼睛区域所表现出的情绪来推断其心理状态的能力，这种能力通常被称为“心理理论”（theory of mind，ToM）。受试者需要依次观察36张人物眼部特写的黑白照片，从4个可能的描述中选择一个最符合照片中人物情绪状态的选项。每个正确的选择得1分，错误的选择得0分，总分为36分，分数越低，表示ToM受损越严重。研究显示RMET具有较高的信效度［29］。本研究中量表的Cronbach’ s α系数为0.925。
1.2.3.6　蒙特利尔认知评估量表（Montreal Cognitive Assessment，MoCA）
该量表是一个快速、简便的认知功能筛查工具，包含视空间和执行功能、命名、记忆、注意力、语言、抽象思维、延迟回忆、定向力等8个认知领域。该测试包含30个项目，总分30分，分数越低表示认知功能受损越严重。研究显示MoCA具有较高的信效度［30-31］。
1.2.3.7　数字符号替换测试量表（Digital Symbol Substitution Test，DSST）
该量表是一种评估受试者加工速度和认知灵活性的简短测试。受试者需要在规定的时间（90 s）内，将一系列数字与相应的符号进行配对，测试其在规定时间内完成配对的速度和准确性。测试的总分是受试者在规定时间内正确匹配的符号数量。研究发现DSST具有很好的信效度［32］。
1.2.4　生活质量评估
帕金森病生活质量问卷（39-Item Parkinson’s disease questionnaire，PDQ-39）是一个专门为PD患者设计的生活质量评估工具，既往研究证实PDQ-39具有很好的信效度［33］。该量表包含39个项目，分为8个领域，包括身体活动、躯体症状、日常活动、心理健康、认知功能、病耻感、社交功能和社会支持。该量表采用Likert 5级（0~4分）评分，总分156分。分数越高，表示受试者的生活质量越差。本研究中量表的Cronbach’s α系数为0.967。
1.3　数据处理与质量控制
研究数据通过纸质病历报告表进行采集，2人同步录入电子数据系统并交叉核验以确保准确性，所有数据按隐私保护规范加密存储。通过系统性数据清洗排除不完整记录，并采用箱线图法与Z分数法识别异常值。进一步将分类变量（如性别、起病侧）编码为数值型，整合人口学特征、疾病参数、运动功能及心理测评数据至统一数据库，确保变量与受试者ID精确匹配。基于变量分布特性及研究假设，选用适当的统计模型和方法进行组间比较，并通过热力图、条形图等可视化工具呈现显著性结果。
研究采用标准化评估流程，以保证评估过程的连贯性和可复制性。运动功能通过ReadyGo™系统定量测定，由PD专病门诊专家操作；心理测评由经统一培训的临床医师实施，严格遵循量表指导语进行中性化施测。
1.4　统计学分析
所有分析采用SPSS 26.0 软件进行，双侧检验中P<0.05定义为差异具有统计学意义。符合正态分布的计量资料以x¯±s表示，计数资料以例表示；组间比较方法通过Shapiro-Wilk检验评估数据正态性。多组间的正态分布数据采用单因素方差分析（ANOVA）比较，非正态数据采用Kruskal-Wallis检验，分类变量采用χ²检验。若组间存在显著性差异，进一步通过Bonferroni校正进行多重比较；效应量与相关性分析：计算ANOVA的效应量η²（表示因变量方差中由自变量解释的比例）及两两比较的效应量δ（标准化均值差）。采用Spearman秩相关分析步态参数与心理量表得分的关联性；亚组分析：正态数据采用独立样本t检验，非正态数据采用Mann-Whitney U检验，并计算组间百分比变化率△。P<0.05为差异具有统计学意义。
2　结果
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2.1　人口学信息和疾病特征信息
各组在性别、年龄、受教育年限、BMI、吸烟和饮酒情况上差异无统计学意义。PD-FOG和PD-NFOG组在病程、起病侧、H&Y分级、LEDD上差异无统计学意义，但2组的UPDRS Ⅲ总分存在显著差异（P<0.05，表1）。
2.2　各组运动功能和心理测评得分的比较
在运动功能参数方面，PD-FOG和PD-NFOG组在步宽、步幅左、步幅右、步高左、步高右、步频左、步频右、跨步速度左、跨步速度右、摆动速度左、摆动速度右、右手摆臂幅度上存在显著差异（P<0.05）；PD-FOG和HC组间在站立相左、摆动相左、步宽、步速、步幅左、步幅右、步高左、步高右、步频左、步频右、跨步速度左、跨步速度右、摆动速度左、摆动速度右、转身时间上存在显著差异（P<0.05）；PD-NFOG和HC组间在步速上存在显著差异（P<0.05，图1）。
在心理测评得分方面，PD-FOG和PD-NFOG组间在MoCA得分上存在显著差异（P<0.05）；PD-FOG和HC组间在所有心理和认知量表得分上均存在显著差异（P<0.05）；PD-NFOG和HC组间在HADS-A、HADS-D、SHAPS、MoCA、DSST、RMET得分上存在显著差异（P<0.05，图2）。
进一步计算显著差异指标的效应量η²，结果显示，中等效应指标分别为RMET［η²=0.716（95%CI：0.611~0.761），P<0.05］、DSST［η²=0.667（95%CI：0.553~0.744），P<0.05］、MoCA［η²=0.597（95%CI：0.425~0.750），P<0.05］，以及步态分析中的步幅右［η²=0.590（95%CI：0.443~0.718），P<0.05］、步幅左［η²=0.563（95%CI：0.403~0.692），P<0.05］和跨步速度左［η²=0.503（95%CI：0.347~0.643），P<0.05］等（图3）。
2.3　PD-FOG组运动功能和心理因素的关联特征
PD-FOG组中，GAD-7得分与转身时间［r=0.415（95%CI：0.011~0.702），P=0.039］、左手摆臂幅度［r=0.519（95%CI：0.144~0.764），P=0.008］呈显著正相关。PHQ-9得分与转身时间［r=0.450（95%CI：0.055~0.724），P=0.024］呈显著正相关。HADS-A得分与H&Y分级［r=0.470（95%CI：0.080~0.735），P=0.018］、HADS-D得分与H&Y分级［r=0.560（95%CI：0.199~0.787），P=0.004］呈显著正相关。SHAPS得分与步频右［r=-0.445（95%CI：-0.720~-0.048），P=0.026］呈显著负相关。MoCA得分与双支撑相左［r=-0.399（95%CI：-0.693~0.007），P=0.048］、双支撑相右［r=-0.404（95%CI：-0.696~0.002），P=0.045］呈显著负相关。DSST得分与UPDRS Ⅲ总分［r=-0.574（95%CI：-0.794~-0.219），P=0.003］呈显著负相关。PDQ-39得分与右手摆臂幅度［r=0.456（95%CI：0.062~0.727），P=0.022］、H&Y分级［r=0.579（95%CI：0.227~0.798），P=0.002］、FOG-Q总分［r=0.422（95%CI：0.020~0.707），P=0.036］呈显著正相关（图4）。
2.4　不同表型PD-FOG的一般信息、运动功能和心理测评得分的比较
TP组和SS组在人口学信息、疾病特征信息上的差异无统计学意义（表2）。运动功能评估中，TP组和SS组在步幅左、步幅右、步频左、步频右方面存在显著差异（P<0.05，图5）。
心理测评得分中，TP组和SS组的组间差异无统计学意义（表3）。进一步计算心理测评得分在组间差异中的效应量δ，结果显示，中等效应指标分别为HADS-A［δ=0.752（95%CI：-0.070~1.558），P=0.072］、SHAPS［δ=0.512（95%CI：-0.291~1.305），P=0.132］和HADS-D得分［δ=0.481（95%CI：-0.321~1.273），P=0.253］。百分比变化率△的计算结果显示，相对于SS组，TP组这3项指标的平均值分别增加了39.0%、8.3%和24.5%（图6）。
3　讨论
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3.1　PD-FOG运动功能与心理因素的特征性改变
本研究发现，PD-FOG相较于PD-NFOG及HC组，在步幅、步频等运动参数及MoCA认知评分上存在显著差异，其中认知功能指标（RMET、DSST、MoCA）效应量最大（η²>0.59），提示认知损伤可能是PD-FOG进展的关键风险因素。与既往研究相符，PD患者的运动功能损伤涉及多个步态参数的输出异常［34-35］，这促使机体更加依赖认知资源的补偿效应，但PD-FOG患者存在执行功能等认知损伤［36］，认知功能无法有效补偿运动自动性缺陷，进一步加剧了PD-FOG的恶化［37］。然而，右利手PD-FOG患者左侧运动障碍的偏侧化模式（如站立相右、摆动相右和右手摆臂幅度无组间差异）与文献报道存在分歧［38-39］，可能源于左侧优势半球运动代偿机制的激活［40-41］。本研究中认知功能指标显示了最大的效应量，提示未来在PD-FOG的临床管理中应整合认知功能的纵向监测，可能为早期识别PD-FOG进展风险及制定个性化干预策略提供重要依据。
3.2　心理因素在PD-FOG中的表型异质性趋势
PD-FOG亚组分析进一步发现，TP型与SS型患者在步幅和步频上存在显著差异，这可能反映了2种表型在步态控制和运动协调上存在不同的病理机制［4］。TP型相较于SS型表现出更明显的焦虑（HADS-A，δ=0.752）、抑郁（HADS-D，δ=0.481）和快感缺失（SHAPS，δ=0.512）趋势，TP型患者膝关节震颤可能是运动程序启动失败后的代偿反应［42-43］，而持续震颤引发的交感神经激活可能加剧焦虑状态［44-45］。值得注意的是，PD-FOG患者情感障碍主要与运动网络（而非边缘系统）功能连接异常相关［7］，支持“干扰模型”在PD-FOG机制中的作用，该模型强调了边缘-认知-运动系统的复杂交互作用［46］。
3.3　心理因素与运动功能之间的广泛关联特征
本研究提示PD-FOG患者心理因素与运动功能之间存在广泛相关趋势，焦虑抑郁、认知损伤与PD-FOG患者疾病严重程度存在相关性。这与既往研究相似［47-49］。焦虑可能通过增加肌肉强直和姿势不稳影响运动协调性，而认知损伤可能因为注意力障碍影响步态稳定性和平衡性［50-52］。这种广泛的潜在关系提示，针对特定心理维度的干预可能改善PD-FOG患者的运动代偿能力。
本研究也存在一定的局限性：①样本来源较单一，样本量较小；②未能充分控制潜在的混杂因素；③缺乏客观的生物学指标以阐明关联机制。未来需要扩大样本量，充分考虑混杂因素，通过多中心前瞻性队列研究验证亚型特异性心理特征，并整合神经影像（如功能性MRI）和生物标志物（如α-突触核蛋白）等客观指标，进一步揭示相关神经生物学机制。
综上所述，PD-FOG患者的运动功能、情绪状态和认知功能存在特征性改变，其中PD患者的认知损伤可能是PD-FOG进展的特征性标志。此外，本研究在亚型层面揭示了不同运动表型PD-FOG患者的心理特征存在表型异质性趋势，这为理解PD-FOG的多系统病理机制及制定表型导向的心理干预策略提供了重要证据。目前针对PD-FOG尚缺乏有效的药物治疗方法，即便是多巴胺反应型FOG的治疗效果依然有限［53］。因此，未来的病理生理机制研究和治疗策略研究均需要综合考量心理因素及相关生物学指标，并根据患者的不同临床表型定制个体化治疗方案。

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2025年第47卷第9期
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doi: 10.16016/j.2097-0927.202412078
  • 接收时间：2024-12-16
  • 首发时间：2026-10-28
  • 出版时间：2025-05-15
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  • 收稿日期：2024-12-16
  • 修回日期：2025-01-10
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    1陆军军医大学（第三军医大学）第一附属医院医学心理科，重庆

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黄河清，E-mail：
HUANG Heqing，E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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