Clinical and physiological assessments for elucidating falls risk in Parkinson's disease

The study aims were to devise (1) a fall risk screen for people with PD using routine clinical measures and (2) an explanatory (physiological) fall risk assessment for guiding fall prevention interventions. One hundred thirteen people with PD (age 66 ± 95% CI 1.6 years) underwent clinical assessment...

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Bibliographic Details
Published in:Movement disorders 2009-07, Vol.24 (9), p.1280-1289
Main Authors: Latt, Mark D., Lord, Stephen R., Morris, John G.L., Fung, Victor S.C.
Format: Article
Language:English
Subjects:
accidental falls
Accidental Falls - prevention & control
Aged
Analysis of Variance
balance
Biological and medical sciences
Blood Pressure - physiology
Chi-Square Distribution
cognitive impairment
Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases
Female
Follow-Up Studies
freezing of gait
Humans
Male
Medical sciences
Middle Aged
muscle strength
Neurologic Examination
Neurology
Neuropsychological Tests
Parkinson Disease - physiopathology
Parkinson Disease - therapy
Parkinson's disease
Predictive Value of Tests
Reaction Time - physiology
Risk Assessment - methods
Risk Factors
Sex Factors
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Summary:The study aims were to devise (1) a fall risk screen for people with PD using routine clinical measures and (2) an explanatory (physiological) fall risk assessment for guiding fall prevention interventions. One hundred thirteen people with PD (age 66 ± 95% CI 1.6 years) underwent clinical assessments and quantitative tests of sway, gait, strength, reaction time, and lower limb sensation. Participants were then followed up for 12 months to determine fall incidence. In the follow‐up year, 51 participants (45%) fell one or more times whereas 62 participants (55%) did not fall. Multivariate analyses of routine clinical measures revealed that a fall in the past year, abnormal axial posture, cognitive impairment, and freezing of gait were independent risk factors for falls and predicted 38/51 fallers (75%) and 45/62 non‐fallers (73%). A multivariate model combining clinical and physiological measures that elucidate the pathophysiology of falls identified abnormal posture, freezing of gait, frontal impairment, poor leaning balance, and leg weakness as independent risk factors. This model correctly classified 39/51 fallers (77%) and 51/62 non‐fallers (82%). Patients with PD at risk of falls can be identified accurately with routine clinical assessments and quantitative physiological tests. Many of the risk factors identified are amenable to targeted intervention. © 2009 Movement Disorder Society
ISSN:0885-3185
1531-8257
DOI:10.1002/mds.22561