Prediction of Falls and/or Near Falls in People with Mild Parkinson’s Disease

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Abstract

Objective

To determine factors associated with future falls and/or near falls in people with mild PD.

Methods

The study included 141 participants with PD. Mean (SD) age and PD-duration were 68 (9.7) and 4 years (3.9), respectively. Their median (q1–q3) UPDRS III score was 13 (8-18). Those >80 years of age, requiring support in standing or unable to understand instructions were excluded. Self-administered questionnaires targeted freezing of gait, turning hesitations, walking difficulties in daily life, fatigue, fear of falling, independence in activities of daily living, dyskinesia, demographics, falls/near falls history, balance problems while dual tasking and pain. Clinical assessments addressed functional balance performance, retropulsion, comfortable gait speed, motor symptoms and cognition. All falls and near falls were subsequently registered in a diary during a six-month period. Risk factors for prospective falls and/or near falls were determined using logistic regression.

Results

Sixty-three participants (45%) experienced ≥1 fall and/or near fall. Three factors were independent predictors of falls and/or near falls: fear of falling (OR = 1.032, p<0.001) history of near falls (OR = 3.475, p = 0.009) and retropulsion (OR = 2.813, p = 0.035). The strongest contributing factor was fear of falling, followed by a history of near falls and retropulsion.

Conclusions

Fear of falling seems to be an important issue to address already in mild PD as well as asking about prior near falls.

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Most cited references 37

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The MoCA: well-suited screen for cognitive impairment in Parkinson disease.

J. Dalrymple-Alford, M. R. MacAskill, C. T. Nakas … (2010)

To establish the diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) when screening externally validated cognition in Parkinson disease (PD), by comparison with a PD-focused test (Scales for Outcomes in Parkinson disease-Cognition [SCOPA-COG]) and the standardized Mini-Mental State Examination (S-MMSE) as benchmarks. A convenience sample of 114 patients with idiopathic PD and 47 healthy controls was examined in a movement disorders center. The 21 patients with dementia (PD-D) were diagnosed using Movement Disorders Society criteria, externally validated by detailed independent functional and neuropsychological tests. The 21 patients with mild cognitive impairment (PD-MCI) scored 1.5 SD or more below normative data in at least 2 measures in 1 of 4 cognitive domains. Other patients had normal cognition (PD-N). Primary outcomes using receiver operating characteristic (ROC) curve analyses showed that all 3 mental status tests produced excellent discrimination of PD-D from patients without dementia (area under the curve [AUC], 87%-91%) and PD-MCI from PD-N patients (AUC, 78%-90%), but the MoCA was generally better suited across both assessments. The optimal MoCA screening cutoffs were <21/30 for PD-D (sensitivity 81%; specificity 95%; negative predictive value [NPV] 92%) and <26/30 for PD-MCI (sensitivity 90%; specificity 75%; NPV 95%). Further support that the MoCA is at least equivalent to the SCOPA-COG, and superior to the S-MMSE, came from the simultaneous classification of the 3 PD patient groups (volumes under a 3-dimensional ROC surface, chance = 17%: MoCA 79%, confidence interval [CI] 70%-89%; SCOPA-COG 74%, CI 62%-86%; MMSE-Sevens item 56%, CI 44%-68%; MMSE-World item 62%, CI 50%-73%). The MoCA is a suitably accurate, brief test when screening all levels of cognition in PD.

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Prospective assessment of falls in Parkinson's disease.

B. R. Bloem, Y Grimbergen, M. Cramer … (2001)

We studied prospectively the epidemiology, clinical impact and prediction of falls in 59 moderately affected patients with Parkinson's disease (PD) (mean UPDRS motor score 31.5; mean age 61 years) and 55 controls (mean age 60 years). At baseline, balance and gait were evaluated extensively. The retropulsion test (response to sudden shoulder pull) was executed first unexpectedly and five more times following prior warning. All persons used standardised scoring forms to document their falls during six months. Thirty patients (50.8 %) and eight controls (14.5%) fell at least once (relative risk [RR] 6.1; 95% confidence interval [CI] 2.5-15.1, p or = 2) falls occurred in 15 patients (25.4%), but in only two controls (RR 9.0; 95 % CI 2.0-41.7; p=0.001). Recurrent falls were more common among persons taking benzodiazepines (RR 5.0; 95% CI 1.6-15.5; p 100; 95% CI 3.1-585) and asking for prior falls (RR 5.0; 95% CI 1.2-20.9). We conclude that falls are common and disabling, even in relatively early stage PD. Recurrent fallers were best predicted by disease severity and presence of prior falls. Strategies to prevent falls in PD should particularly focus at intrinsic (patient-related) factors, such as minimising the use of benzodiazepines.

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Predictors of future falls in Parkinson disease.

Charles Worringham, Peter Silburn, J. Wood … (2010)

Falls are a major health and injury problem for people with Parkinson disease (PD). Despite the severe consequences of falls, a major unresolved issue is the identification of factors that predict the risk of falls in individual patients with PD. The primary aim of this study was to prospectively determine an optimal combination of functional and disease-specific tests to predict falls in individuals with PD. A total of 101 people with early-stage PD undertook a battery of neurologic and functional tests in their optimally medicated state. The tests included Tinetti, Berg, Timed Up and Go, Functional Reach, and the Physiological Profile Assessment of Falls Risk; the latter assessment includes physiologic tests of visual function, proprioception, strength, cutaneous sensitivity, reaction time, and postural sway. Falls were recorded prospectively over 6 months. Forty-eight percent of participants reported a fall and 24% more than 1 fall. In the multivariate model, a combination of the Unified Parkinson's Disease Rating Scale (UPDRS) total score, total freezing of gait score, occurrence of symptomatic postural orthostasis, Tinetti total score, and extent of postural sway in the anterior-posterior direction produced the best sensitivity (78%) and specificity (84%) for predicting falls. From the UPDRS items, only the rapid alternating task category was an independent predictor of falls. Reduced peripheral sensation and knee extension strength in fallers contributed to increased postural instability. Falls are a significant problem in optimally medicated early-stage PD. A combination of both disease-specific and balance- and mobility-related measures can accurately predict falls in individuals with PD.

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Author and article information

Contributors

Mathias Toft: Role: Academic Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 30 January 2015

Publication date Collection: 2015

Volume: 10

Issue: 1

Electronic Location Identifier: e0117018

Affiliations

[1 ]Department of Neurology, Skåne University Hospital, Malmö, Sweden

[2 ]The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden

[3 ]Department of Clinical Sciences, Lund University, Malmö, Sweden

[4 ]Memory Clinic, Skåne University Hospital, Malmö, Sweden

[5 ]Department of Health Sciences, Lund University, Lund, Sweden

Oslo University Hospital, NORWAY

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: BL PH OH MHN. Performed the experiments: BL. Analyzed the data: BL MHN PH. Wrote the paper: BL MHN. Performed data collection: BL. Drafted the initial manuscript: BL MHN. Participated in data interpretation and writing (and approving) the final version of the manuscript: BL PH OH MHN.

* E-mail: Beata.Lindholm@ 123456med.lu.se

Article

Publisher ID: PONE-D-14-30731

DOI: 10.1371/journal.pone.0117018

PMC ID: 4311993

PubMed ID: 25635687

SO-VID: 0d222df2-b73d-41d7-a08e-416cea0161f8

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

History

Date received : 10 July 2014

Date accepted : 17 December 2014

Page count

Figures: 0, Tables: 4, Pages: 11

Funding

This work was supported by grants from the Swedish Parkinson Academy, the Stoltz fund (Department of Neurology, Malmö, Skåne University Hospital, Sweden), the Academy of Caring Sciences (Skåne University Hospital, Sweden), Skane county council’s research and development foundation, and the strategic research area for neuroscience at Lund University (MultiPark), Sweden. None of the funders had any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The study was accomplished within BAGADILICO (the Basal Ganglia Disorders Linnaeus Consortium) research consortium at Lund University, Sweden, and within the context of the Centre for Ageing and Supportive Environments (CASE) at Lund University, financed by the Swedish Council for Working Life, Public Health and Welfare (Forte).

Custom metadata

Data Availability Due to ethical restrictions, the data will not be shared publicly, but an ethically compliant data set will be made available to interested researchers on request. Data underlying the results described in our manuscript are available from: Att. Beata Lindholm, Department of Neurology, Skåne University Hospital, Jan Waldenströms gata 15/19, 205 02 Malmö, Sweden.

Prediction of Falls and/or Near Falls in People with Mild Parkinson’s Disease

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Abstract

Objective

Methods

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Conclusions

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Most cited references 37

The MoCA: well-suited screen for cognitive impairment in Parkinson disease.

Prospective assessment of falls in Parkinson's disease.

Predictors of future falls in Parkinson disease.

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