Causes and consequences of falls in Parkinson disease patients in a prospective study

Rudzińska, Monika; Bukowczan, Sylwia; Stożek, Joanna; Zajdel, Katarzyna; Mirek, Elżbieta; Chwata, Wiesław; Wójcik-Pędziwiatr, Magdalena; Banaszkiewicz, Krzysztof; Szczudlik, Andrzej

doi:10.5114/ninp.2013.38222

Cited by 57 publications

(32 citation statements)

References 22 publications

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“…There exists an association between nocturia and the risk for falls and hip fractures . This becomes particularly relevant to PD where patients are at risk for falls, and a prevalence of 54% in PD patients compared to 18% in age‐matched healthy participants was reported in one study …”

Section: The Impact Of Nocturiamentioning

confidence: 98%

Nocturia in Parkinson's Disease: Why Does It Occur and How to Manage?

Batla¹,

Phé

Min

et al. 2016

Movement Disord Clin Pract

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Background: Nocturia is one of the commonest nonmotor symptoms in Parkinson's disease (PD) and has a significant impact on quality of life both for patients and their carers. There exists a relation between nocturia and poor sleep quality, falls, and institutionalization. Nocturia may manifest as a result of reduced functional bladder capacity or nocturnal polyuria; however, most often the cause is multifactorial. Disorders of circadian rhythm regulation are known to occur with sleep disturbances in PD may also contribute to nocturia. Methods and Results: In this review, an overview of the assessment and management of nocturia in patients with PD is presented. History taking, medication review, and a bladder diary form the cornerstone of the evaluation. Urinalysis, ultrasonography, and urodynamic studies help to assess the cause for lower urinary tract symptoms and exclude concomitant pathologies, such as bladder outlet obstruction. Antimuscarinic medications are the first-line treatment for the overactive bladder; however, caution is needed when using these medications in individuals predisposed to cognitive impairment. Desmopressin is effective for managing nocturnal polyuria. Conclusions: An individualized approach is recommended to optimize the management of nocturia in PD.Parkinson's disease (PD) is characterized predominantly by motor complaints, consisting of bradykinesia, rigidity, and rest tremor and gait disturbances. However nonmotor symptoms (NMS) commonly accompany these motor symptoms.1 Lower urinary tract (LUT) symptoms are common in PD and include storage symptoms (urinary urgency, increased daytime frequency, and nocturia, with or without incontinence) and voiding symptoms (urinary hesitancy, interrupted or poor stream, and double voiding). 2,3 The prevalence of LUT symptoms varies between 38% and 71%, 4,5 and its severity increases with progression of PD, paralleling other manifestations of autonomic dysfunction. 6Urinary symptoms are an important cause for morbidity in PD, having a devastating impact on quality of life, and have been recognized by Parkinson's UK as one of the top 10 priority areas for research in PD. 7Using a standardized validated questionnaire of NMS, the NMS Quest, nocturia was found to be the most common LUT symptom, reported by more than 60% of participants.8 Nocturia was, in fact, reported to be the commonest NMS reported in this study. The cause for nocturia in PD is poorly understood; however, it is likely to be multifactorial. [9][10][11] We review the pathophysiology of nocturia in PD and principles for management. Prevalence of Nocturia in PDQuestionnaire based studies generally report a high prevalence of nocturia, with figures ranging between 76% 12 and 86%, 13,14 though one study reported a prevalence of only 34.6%. 15 In a study of 115 PD patients using a questionnaire on pelvic organ functions, Sakakibara et al. reported nocturia (or nighttime frequency) in 53% of men and 63% of women with PD.16

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Section: The Impact Of Nocturiamentioning

confidence: 98%

Nocturia in Parkinson's Disease: Why Does It Occur and How to Manage?

Batla¹,

Phé

Min

et al. 2016

Movement Disord Clin Pract

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“…Falling in PD patients happens in various situations 7 , and diverse parkinsonian motor and non-motor symptoms, including mood and cognitive disorders, have been reported to be associated with falls in PD patients 2, 8–12 . Additionally, PD patients fall in multiple directions, and different body parts are injured during such falls 5, 10 .…”

Section: Introductionmentioning

confidence: 99%

Falling Direction can Predict the Mechanism of Recurrent Falls in Advanced Parkinson’s Disease

Youn

Okuma

Hwang

et al. 2017

Sci Rep

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Falls are a common and disabling symptom in patients with Parkinson’s disease (PD). For prevention, it is important to understand the pathophysiology of falls in PD patients, but the predictors for the possible mechanisms underlying such falls have not been clearly elucidated. In this prospective observational study, we investigated the implications of falling direction to predict the mechanisms of recurrent falls in PD patients. We enrolled 62 recurrent fallers with PD and divided them into two groups according to the main falling directions: 45 PD fallers who fell forward (forward fallers), and 17 PD fallers who fell in the other directions (non-forward fallers). Although there was no difference in demographic data, parkinsonism, or frontal lobe function, forward fallers showed more severe falls and tended to fall during walking or turning, while non-forward fallers usually fell during sitting/standing or turning. Additionally, forward fallers revealed higher score on a freezing of gait (FOG) questionnaire. Logistic regression analysis demonstrated that FOG was associated with falling forward, while balance impairment, akinetic-rigid subtype, and neuropsychiatric symptoms were associated with falling into the other directions. Our results indicate that FOG and balance impairment are two major mechanisms for recurrent falling in PD patients, and falling direction is an important predictor for these mechanisms.

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“…[59][60][61] In 12% of the PD cases, the cause of a fall was attributed to dizziness. 62 The risk of a fall and the report of dizziness in patients with PD can significantly be reduced with balance training 17 or VREs. 63,64 However, falls in patients with PD are not solely caused by dizziness but have been related to tremor, freezing, retropulsion, and rigidity.…”

Section: Yellow Flags From Non-behavioral Disordersmentioning

confidence: 99%

“…63,64 However, falls in patients with PD are not solely caused by dizziness but have been related to tremor, freezing, retropulsion, and rigidity. 62 All causes of falls should be assessed and addressed early in the course of rehabilitation in order to improve clinical outcomes.…”

Section: Yellow Flags From Non-behavioral Disordersmentioning

confidence: 99%

A physical therapist classification system for persons with complaints of dizziness and balance dysfunction

Alrwaily

Whitney

Holmberg

2015

Physical Therapy Reviews

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Background: Dizziness is a very challenging condition to diagnose and treat. Patients with dizziness are increasingly consulting physical therapists in direct access clinics, and commonly require vestibular rehabilitation exercises (VREs). To optimize the effect of VREs, physical therapists should be able to determine whether the patient with dizziness is appropriate for VREs or should be referred to other healthcare providers. Objectives: The purpose of this paper is to describe a screening procedure that will assist physical therapists in the clinical decision-making process for the person presenting with dizziness in direct access clinics. Major Findings: Patients with dizziness can be classified into three subgroups: red flags, yellow flags, and green flags. Red flags are patients with dizziness for whom VRE intervention is not appropriate unless a physician has already cleared them. Yellow flags are patients with dizziness who can benefit from a VRE intervention, however, they present with comorbid disorders that warrant consultation with other healthcare practitioners in order to maximize the effect of the VRE intervention. Green flags are patients who will benefit from VRE intervention without referral. Conclusions: The screening procedure classifies patients with dizziness into three subgroups: red flags, yellow flags, and green flags. Red flags are patients with dizziness for whom VRE intervention is not appropriate unless a physician has already cleared them. Yellow flags are patients with dizziness who can benefit from a VRE intervention, however, they present with comorbid disorders that warrant consultation with other healthcare practitioners in order to maximize the effect of the VRE intervention. Green flags are patients who will benefit from VRE intervention without referral.

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Causes and consequences of falls in Parkinson disease patients in a prospective study

Abstract: Intrinsic factors are the most common causes of falls in PD. Every third fall intensifies fear of walking and causes injuries.

Cited by 57 publications

References 22 publications

Nocturia in Parkinson's Disease: Why Does It Occur and How to Manage?

Nocturia in Parkinson's Disease: Why Does It Occur and How to Manage?

Falling Direction can Predict the Mechanism of Recurrent Falls in Advanced Parkinson’s Disease

A physical therapist classification system for persons with complaints of dizziness and balance dysfunction

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