Construction of a nomogram predictive model for freezing of gait in patients with Parkinson's disease

doi:10.11958/20221288

Abstract

Abstract:

Objective To investigate and analyze the incidence and risk factors of freezing of gait (FOG) in patients with Parkinson's disease (PD), construct and verify the quantitative nomogram predictive model. Methods A total of 208 PD patients were retrospectively summarized. According to clinical symptoms, 98 patients were diagnosed as the FOG group and 110 patients were diagnosed as the non-FOG group. Univariate and multivariate Logistic regression analysis were used to screen risk factors of FOG, and the nomogram model was established. Results Univariate comparison showed that age, initial age of PD, course of PD, scores of PD questionnaire (PDQ39), Hamilton depression scale (HAMD-17) and anxiety scale (HAMA-14), rapid eye movement sleep behavior disorder screening questionnaire (RBDSQ) and Pittsburgh sleep quality index (PSQI) were significantly higher in the FOG group than those in the non-FOG group. The visuospatial dysfunction and modified Hoehn-Yahr (H-Y) grade were significantly higher in the FOG group than those in the non-FOG group, while the score of Mini Mental State Examination (MMSE) was less in the FOG group (P<0.05). Multivariate Logistic regression analysis showed that higher RBDSQ score (OR=2.724, 95%CI: 1.458-5.090), PDQ39 score (OR=7.358, 95%CI: 2.448-22.078), visuospatial dysfunction (OR=2.134, 95%CI: 1.349-3.376) and H-Y grade (OR=4.272, 95%CI: 1.886-9.673) were independent risk factors to FOG in PD patients. R software was used to establish the nomogram model, and total score was 120. The area under the curve (AUC) of the model for predicting FOG by receiver operating curve (ROC) was 0.867 (95%CI: 0.810-0.935, P<0.001), suggesting that the predictive efficiency of the model was good. Hosmer - lemeshow test showed that the goodness of fit of the model was good (χ²=2.635, P=0.642). The calibration curve showed that the predictive probability of the model was in good agreement with the actual incidence. The decision curve showed that the benefit of the model was acceptable. Conclusion Patients with PD have a high incidence of FOG. RBDSQ score, PDQ 39 score, visuospatial dysfunction and H-Y grade are independent risk factors. The established nomogram model is effective in predicting FOG.

Key words: Parkinson's disease, freezing of gait, risk factors, nomogram

CLC Number:

R745.7

Figures/Tables 6

References 23

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组别		n		性别（男/女）			年龄（岁）			PD首发年龄（岁）			PD病程（年）			临床分型（TD/PIGD）			多巴胺治疗史
无FOG组		110		59/51			61.2±4.4			56.6±3.8			3（1，7）			62/48			51（46.4）
FOG组		98		53/45			70.5±5.3			64.5±4.2			5（2，9）			59/39			45（45.9）
χ²、t或Z				0.004			13.817^＊＊			14.257^＊＊			1.869^＊＊			0.314			0.004
组别	服药年限（年）				剂量（mg/d）			起始症状侧别（左/右）			不宁腿综合征			RBDSQ评分（分）			PSQI评分（分）			PDQ39评分（分）
无FOG组	4（1，8）				246.9±52.3			46/64			46（41.8）			2（0，8）			8（2，16）			35.6±8.9
FOG组	3（1，6）				256.4±45.2			44/54			39（39.8）			4（2，10）			11（5，23）			59.5±10.2
χ²、t或Z	0.568				1.393			0.200			0.088			2.032^＊			2.523^＊			18.046^＊＊
组别			视空间功能障碍			MMSE评分（分）			HAMD-17 评分（分）			HAMA-14 评分（分）			SCOPA-COG 评分（分）			H-Y分级
组别			视空间功能障碍			MMSE评分（分）			HAMD-17 评分（分）			HAMA-14 评分（分）			SCOPA-COG 评分（分）			1—2级			3—5级
无FOG组			16（14.5）			26.5±3.9			42.3±8.7			39.8±5.4			2（0，4）			76（69.1）			34（30.9）
FOG组			30（30.6）			23.5±3.4			56.4±9.5			52.1±10.6			3（1，6）			53（54.1）			45（45.9）
χ²、t或Z			7.767^＊＊			5.882^＊＊			11.172^＊＊			12.764^＊＊			0.659			4.957^＊

组别		n		性别（男/女）			年龄（岁）			PD首发年龄（岁）			PD病程（年）			临床分型（TD/PIGD）			多巴胺治疗史
无FOG组		110		59/51			61.2±4.4			56.6±3.8			3（1，7）			62/48			51（46.4）
FOG组		98		53/45			70.5±5.3			64.5±4.2			5（2，9）			59/39			45（45.9）
χ²、t或Z				0.004			13.817^＊＊			14.257^＊＊			1.869^＊＊			0.314			0.004
组别	服药年限（年）				剂量（mg/d）			起始症状侧别（左/右）			不宁腿综合征			RBDSQ评分（分）			PSQI评分（分）			PDQ39评分（分）
无FOG组	4（1，8）				246.9±52.3			46/64			46（41.8）			2（0，8）			8（2，16）			35.6±8.9
FOG组	3（1，6）				256.4±45.2			44/54			39（39.8）			4（2，10）			11（5，23）			59.5±10.2
χ²、t或Z	0.568				1.393			0.200			0.088			2.032^＊			2.523^＊			18.046^＊＊
组别			视空间功能障碍			MMSE评分（分）			HAMD-17 评分（分）			HAMA-14 评分（分）			SCOPA-COG 评分（分）			H-Y分级
组别			视空间功能障碍			MMSE评分（分）			HAMD-17 评分（分）			HAMA-14 评分（分）			SCOPA-COG 评分（分）			1—2级			3—5级
无FOG组			16（14.5）			26.5±3.9			42.3±8.7			39.8±5.4			2（0，4）			76（69.1）			34（30.9）
FOG组			30（30.6）			23.5±3.4			56.4±9.5			52.1±10.6			3（1，6）			53（54.1）			45（45.9）
χ²、t或Z			7.767^＊＊			5.882^＊＊			11.172^＊＊			12.764^＊＊			0.659			4.957^＊

因素	β	SE	Wald χ²	P	OR	OR 95%CI
RBDSQ评分	1.002	0.319	9.854	<0.001	2.724	1.458~5.090
PDQ39评分	1.995	0.561	12.646	<0.001	7.358	2.448~22.078
视空间功能障碍	0.758	0.234	10.493	<0.001	2.134	1.349~3.376
H-Y分级	1.452	0.417	12.124	<0.001	4.272	1.886~9.673
常数项	2.146	0.569	14.224	<0.001	8.551

因素	β	SE	Wald χ²	P	OR	OR 95%CI
RBDSQ评分	1.002	0.319	9.854	<0.001	2.724	1.458~5.090
PDQ39评分	1.995	0.561	12.646	<0.001	7.358	2.448~22.078
视空间功能障碍	0.758	0.234	10.493	<0.001	2.134	1.349~3.376
H-Y分级	1.452	0.417	12.124	<0.001	4.272	1.886~9.673
常数项	2.146	0.569	14.224	<0.001	8.551