Falls in Parkinson Disease: Analysis of a Large Cross-Sectional Cohort

Parashos, Sotirios A.; Wielinski, Catherine L.; Giladi, Nir; Gurevich, Tanya

doi:10.3233/jpd-130249

Cited by 26 publications

(27 citation statements)

References 38 publications

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“…In the CamPaIGN study, an incident PD cohort study ( n = 142) based in the UK, the level of medical comorbidities was an independent predictor of the likelihood of progressing to Hoehn and Yahr stage 3. Other observational PD studies have shown comorbidity burden to be a clear risk factor for gait and mobility symptoms . Compared to middle‐age subjects, older individuals diagnosed with PD tend to have disproportionately more axial motor impairments and a greater burden of comorbidities .…”

Section: Limitations Of Motor Subtypesmentioning

confidence: 99%

Is PIGD a legitimate motor subtype in Parkinson disease?

Kotagal

2016

Ann Clin Transl Neurol

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Parkinson disease is a chronic progressive syndrome with a broad array of clinical features. Different investigators have suggested the heterogeneous motor manifestations of early Parkinson disease can be conceptualized through a taxonomy of clinical subtypes including tremor‐predominant and postural instability and gait difficulty‐predominant subtypes. Although it is theoretically valuable to distinguish subtypes of Parkinson disease, the reality is that few patients fit these discrete categories well and many transition from exhibiting elements of one subtype to elements of another. In the time since the initial description of the postural instability and gait difficulty‐predominant subtype, Parkinson disease clinical research has blossomed in many ways – including an increased emphasis on the role of medical comorbidities and extranigral pathologies in Parkinson disease as markers of prognostic significance. By conceptualizing the pathogenesis of an expansive disease process in the limited terms of categorical motor subtypes, we run the risk of overlooking or misclassifying clinically significant pathogenic risk factors that lead to the development of motor milestones such as falls and related axial motor disability. Given its critical influence on quality of life and overall prognosis, we are in need of a model of postural instability and gait difficulty–predominant features in Parkinson disease that emphasizes the overlooked pathological influence of aging and medical comorbidities on the development of axial motor burden and postural instability and gait difficulty‐predominant features. This Point of View proposes thinking of postural instability and gait difficulties in Parkinson disease not as a discrete subtype, but rather as multidimensional continuum influenced by several overlapping age‐related pathologies.

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Section: Limitations Of Motor Subtypesmentioning

confidence: 99%

Is PIGD a legitimate motor subtype in Parkinson disease?

Kotagal

2016

Ann Clin Transl Neurol

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“…A high number of fallers among participants with PD has been described previously . A similar prospective cohort study followed 100 PD patients and 55 matched controls .…”

Section: Discussionmentioning

confidence: 57%

“…A high number of fallers among participants with PD has been described previously. 23,24 A similar prospective cohort study followed 100 PD patients and 55 matched controls. 24 After 1 year, 54% of PD patients and 18% of controls had experienced falls.…”

Section: Discussionmentioning

confidence: 99%

Home‐Based Monitoring of Falls Using Wearable Sensors in Parkinson's Disease

et al. 2019

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Introduction Falling is among the most serious clinical problems in Parkinson's disease (PD). We used body‐worn sensors (falls detector worn as a necklace) to quantify the hazard ratio of falls in PD patients in real life. Methods We matched all 2063 elderly individuals with self‐reported PD to 2063 elderly individuals without PD based on age, gender, comorbidity, and living conditions. We analyzed fall events collected at home via a wearable sensor. Fall events were collected either automatically using the wearable falls detector or were registered by a button push on the same device. We extracted fall events from a 2.5‐year window, with an average follow‐up of 1.1 years. All falls included were confirmed immediately by a subsequent telephone call. The outcomes evaluated were (1) incidence rate of any fall, (2) incidence rate of a new fall after enrollment (ie, hazard ratio), and (3) 1‐year cumulative incidence of falling. Results The incidence rate of any fall was higher among self‐reported PD patients than controls (2.1 vs. 0.7 falls/person, respectively; P < .0001). The incidence rate of a new fall after enrollment (ie, hazard ratio) was 1.8 times higher for self‐reported PD patients than controls (95% confidence interval, 1.6–2.0). Conclusion Having PD nearly doubles the incidence of falling in real life. These findings highlight PD as a prime “falling disease.” The results also point to the feasibility of using body‐worn sensors to monitor falls in daily life. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

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“…On the other hand, the association of NMS and falling risk has scarcely been explored. Some studies have associated falling risk with cognitive impairment 19,27 , rapid eye movement sleep behavioral disorders 13,28 , autonomic dysfunction 29 , depression 30 , cardiovascular comorbidity 31 and urinary incontinence 14 . In our study, in the NMSS genitourinary domain, miscellaneous and total scores were higher among fallers, although none of these variables were shown to be independent predictors within the regression model.…”

Section: Discussionmentioning

confidence: 99%

Falls in persons with Parkinson's disease: Do non-motor symptoms matter as much as motor symptoms?

Alvarado-Bolaños

Cervantes-Arriaga

Arredondo-Blanco

et al. 2019

Arq. Neuro-Psiquiatr.

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Falls are common among persons with Parkinson's disease (PD). On the other hand, predicting falls is complex as there are both generic and PD-specific contributors. In particular, the role of non-motor symptoms has been less studied. Objective: The objective of this study was to identify the role of non-motor predictors of falling in persons with PD (PwP). Methods: A cross-sectional study was carried out in PwP recruited from a movement disorders clinic. Clinical and demographical data were collected. All PwP were assessed using the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and the Non-Motor Symptoms Scale (NMSS). Variables were assessed at the bivariate level. Significant variables were put into a logistic regression model. Results: A total of 179 PwP were included. Overall, 16.8% of PwP had fallen in the past 12 months, with 53.3% of them being recurrent fallers. The mean number of monthly falls was 2.5 ± 3.3. Factors associated with falling in the bivariate analysis included the disease duration, Hoehn and Yahr stage, MDS-UPDRS part I and II, postural instability/gait disturbance (PIGD) subtype, NMSS urinary domain, NMSS miscellaneous domain, and non-motor severity burden (all p-values < 0.05). After multivariate analysis, only the disease duration (p = 0.03) and PIGD (p = 0.03) remained as independent risk factors. Conclusion: Disease duration and the PIGD subtype were identified as relevant risk factors for falls in PwP Non-motor symptoms appear to have a less important role as risk factors for falls.

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Falls in Parkinson Disease: Analysis of a Large Cross-Sectional Cohort

Cited by 26 publications

References 38 publications

Is PIGD a legitimate motor subtype in Parkinson disease?

Is PIGD a legitimate motor subtype in Parkinson disease?

Home‐Based Monitoring of Falls Using Wearable Sensors in Parkinson's Disease

Falls in persons with Parkinson's disease: Do non-motor symptoms matter as much as motor symptoms?

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