Two-Year Trajectory of Fall Risk in People With Parkinson Disease: A Latent Class Analysis

Objective: Falls are major problems for people with Parkinson's disease. This study aimed to determine fall frequency, and the relation of socio-demographic and clinical factors in idiopathic Parkinson's disease (IPH). Materials and Methods:Eighty-seven patients with IPH who were under follow-up in Erciyes University Faculty of Medicine, Neurology Department [37 females (42.5%), and 50 males (57.5%)] were included in the study. The participants were evaluated with neurologic examination, mini-mental state examination, the Unified Parkinson's Disease Rating Scale (UPDRS), 6-meter walking test, turning time, freezing phenomenon, Hoehn and Yahr (H&Y) Scale, and ranking of fear of falls. Fall was recorded as history of fall in the 6 months before testing.Results: A total of 22 (25.3%) patients reported a fall in the 6-month period before testing. Twenty-five patients (28.7%) were stage 1.5, and 22 (25.3%) were stage 2 according to the H&Y Scale. Freezing phenomenon was observed in 34 39.1%) patients. There was no significant difference between patients with and without a history of falls according to age, sex, education, occupation, and marital status (p>0.05). According to disease period, H&Y Scale and the UPDRS, motor, turning time 360 degrees from right, turning time 360 degrees from left, balance defect at 360 degrees right turning, balance defect at 360 degrees left turning, and freezing phenomenon there were no significant difference between those with and without a history of fall (p>0.05). There was a significant difference between those who had fallen and had not fallen according to UPDRS-mental, UPDRS-ADL, degree of fear of falling, 6-m walking time, 6-m walking test, and number of steps (p<0.05). Conclusion:Our study showed that frequency of falls and walking speed, fear of falling, activities of daily living, and mental function are important factors for falls in IPH. Fall assessment in IPH is needed for a multifactorial approach and determining these factors will be helpful for taking measures against falls.

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“…The frequency of falls are 38-68% in the literature (16,17,18). We found a frequency of 25.3% in our study.…”

Section: Discussionsupporting

confidence: 62%

Frequency of Falls and Relationship Between Falls, Socio-demographic and Clinical

Soyuer¹,

Cankurtaran²,

Gültekın³

et al. 2017

tnd

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“…[59] Several studies have utilized LCA and a related approach, latent profile analysis (LPA), to examine subgroups of PD patients according to motor, psychiatric, or cognitive presentations. [60]–[65] Although two studies[64], [65] included examination of neuropsychological test performance, this was not the primary outcome variable of interest. This current study is the first to utilize LCA to examine cognition in PD as the primary outcome.…”

Section: Discussionmentioning

confidence: 99%

Neuropsychological Subgroups in Non-Demented Parkinson’s Disease: A Latent Class Analysis

Brennan

Devlin

Xie

et al. 2017

JPD

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Background Methods to detect early cognitive decline and account for heterogeneity of deficits in Parkinson's disease (PD) are needed. Quantitative methods such as latent class analysis (LCA) offer an objective approach to delineate discrete phenotypes of impairment. Objective To identify discrete neurocognitive phenotypes in PD patients without dementia. Methods LCA was applied to a battery of 8 neuropsychological measures to identify cognitive subtypes in a cohort of 199 non-demented PD patients. Two measures were analyzed from each of four neurocognitive domains: executive functioning, memory, visuospatial abilities, and language. Additional analyses examined between-groups differences in demographic and clinical characteristics (Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory [ADCS-ADL]; UPDRS-III; PD subtype (i.e., tremor-dominant (TD) versus postural instability/gait disturbance-dominant(PIGD)); and cognitive diagnosis (i.e., intact cognition versus mild cognitive impairment; MCI). Results LCA identified 3 distinct groups of PD patients: an intact cognition group (n=109; 54.8%), an amnestic group (n=64[32.1%]; impaired recall and recognition on verbal memory tasks, but intact performance on other measures) and a mixed impairment group with dysexecutive, visuospatial and lexical retrieval deficits (n=26 [13.1%]; relative deficits on measures of verbal fluency, visuospatial abilities, and delayed free recall on a memory task, but intact recognition memory). The amnestic and mixed impairment groups had significantly lower ratings of IADL functioning and greater motor symptoms than the cognitively intact group. Additionally, patients with PIGD vs. TD PD subtype were more likely to be classified in either cognitively impaired group. Of those diagnosed as cognitively normal according to MDS criteria (n=151), LCA classified 35 patients as amnestic (23.2%), and 15 as mixed impairment (9.9%). Conclusions Non-demented PD patients exhibit distinct neuropsychological profiles. One-third of patients with LCA-determined impairment were diagnosed as cognitively intact by expert consensus, indicating that classification using a statistical algorithm may assist in detection of early and subtle cognitive decline. This study also demonstrates that memory impairment is common in non-demented PD even when cognitive impairment is not clinically apparent. This study has implications for earlier detection of cognitive difficulties in PD, predicting eventual emergence of significant cognitive decline, and treatment trials for cognitive dysfunction in PD.

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“…Moreover, gait seems to be more stable when the arm swing is amplified and could normalize the gait speed and the step length in this population [ 38 ]. As already highlighted by Punt et al, this finding is important as the fall risk is already high for the elderly, and even more so in PD [ 39 , 40 ]. From this point of view, including arm swing in rehabilitation programmes, it seems to be an interesting strategy to normalize the PD gait pattern [ 38 , 41 ].…”

Section: Discussionmentioning

confidence: 92%

Does Nordic Walking restore the temporal organization of gait variability in Parkinson’s disease?

Warlop

Detrembleur

Lopez³

et al. 2017

J NeuroEngineering Rehabil

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BackgroundGait disorders of Parkinson’s disease (PD) are characterized by the breakdown of the temporal organization of stride duration variability that was tightly associated to dynamic instability in PD. Activating the upper body during walking, Nordic Walking (NW) may be used as an external cueing to improve spatiotemporal parameters of gait, such as stride length or gait variability, in PD. The aim of this study was to evaluate the beneficial effects of NW on temporal organization of gait variability and spatiotemporal gait variables in PD.MethodsFourteen mild to moderate PD participants and ten age-matched healthy subjects performed 2 × 12 min overground walking sessions (with and without pole in a randomized order) at a comfortable speed. Gait speed, cadence, step length and temporal organization (i.e. long-range autocorrelations; LRA) of stride duration variability were studied on 512 consecutive gait cycles using a unidimensional accelerometer placed on the malleola of the most affected side in PD patients and of the dominant side in healthy controls. The presence of LRA was determined using the Rescaled Range Analysis (Hurst exponent) and the Power Spectral Density (α exponent). To assess NW and disease influences on gait, paired t-tests, Z-score and a two-way (pathological condition x walking condition) ANOVA repeated measure were used.ResultsLeading to significant improvement of LRA, NW enhances step length and reduces gait cadence without any change in gait speed in PD. Interestingly, LRA and step length collected from the NW session are similar to that of the healthy population.ConclusionThis cross-sectional controlled study demonstrates that NW may constitute a powerful way to struggle against the randomness of PD gait and the typical gait hypokinesia. Involving a voluntary intersegmental coordination, such improvement could also be due to the upper body rhythmic movements acting as rhythmical external cue to bypass their defective basal ganglia circuitries.Ethics committee’s reference numberB403201318916Trial registration NCT02419768

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Two-Year Trajectory of Fall Risk in People With Parkinson Disease: A Latent Class Analysis

Cited by 23 publications

References 36 publications

Frequency of Falls and Relationship Between Falls, Socio-demographic and Clinical

Frequency of Falls and Relationship Between Falls, Socio-demographic and Clinical

Neuropsychological Subgroups in Non-Demented Parkinson’s Disease: A Latent Class Analysis

Does Nordic Walking restore the temporal organization of gait variability in Parkinson’s disease?

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