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      Risk of Falls in Parkinson's Disease: A Cross-Sectional Study of 160 Patients

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      Author(s): 1 , 1, 2 , *
      Publication date (Electronic):
      Journal: Parkinson's Disease
      Publisher: Hindawi Publishing Corporation

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          Abstract

          Falls are a major source of disability in Parkinson's disease. Risk factors for falling in Parkinson's disease remain unclear. To determine the relevant risk factors for falling in Parkinson's disease, we screened 160 consecutive patients with Parkinson's disease for falls and assessed 40 variables. A comparison between fallers and nonfallers was performed using statistical univariate analyses, followed by bivariate and multivariate logistic regression, receiver-operating characteristics analysis, and Kaplan-Meier curves. 38.8% of patients experienced falls since the onset of Parkinson's disease (recurrent in 67%). Tinetti Balance score and Hoehn and Yahr staging were the best independent variables associated with falls. The Tinetti Balance test predicted falls with 71% sensitivity and 79% specificity and Hoehn and Yahr staging with 77% sensitivity and 71% specificity. The risk of falls increased exponentially with age, especially from 70 years onward. Patients aged >70 years at the onset of Parkinson's disease experienced falls significantly earlier than younger patients.

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          Risk factors for falls among elderly persons living in the community.

          Mary E. Tinetti, Mark Speechley, Sandra F. Ginter (1988)
          To study risk factors for falling, we conducted a one-year prospective investigation, using a sample of 336 persons at least 75 years of age who were living in the community. All subjects underwent detailed clinical evaluation, including standardized measures of mental status, strength, reflexes, balance, and gait; in addition, we inspected their homes for environmental hazards. Falls and their circumstances were identified during bimonthly telephone calls. During one year of follow-up, 108 subjects (32 percent) fell at least once; 24 percent of those who fell had serious injuries and 6 percent had fractures. Predisposing factors for falls were identified in linear-logistic models. The adjusted odds ratio for sedative use was 28.3; for cognitive impairment, 5.0; for disability of the lower extremities, 3.8; for palmomental reflex, 3.0; for abnormalities of balance and gait, 1.9; and for foot problems, 1.8; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables. The risk of falling increased linearly with the number of risk factors, from 8 percent with none to 78 percent with four or more risk factors (P less than 0.0001). About 10 percent of the falls occurred during acute illness, 5 percent during hazardous activity, and 44 percent in the presence of environmental hazards. We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling.
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            The role of executive function and attention in gait.

            Galit Yogev-Seligmann, Jeffrey M. Hausdorff, Nir Giladi (2008)
            Until recently, gait was generally viewed as a largely automated motor task, requiring minimal higher-level cognitive input. Increasing evidence, however, links alterations in executive function and attention to gait disturbances. This review discusses the role of executive function and attention in healthy walking and gait disorders while summarizing the relevant, recent literature. We describe the variety of gait disorders that may be associated with different aspects of executive function, and discuss the changes occurring in executive function as a result of aging and disease as well the potential impact of these changes on gait. The attentional demands of gait are often tested using dual tasking methodologies. Relevant studies in healthy adults and patients are presented, as are the possible mechanisms responsible for the deterioration of gait during dual tasking. Lastly, we suggest how assessments of executive function and attention could be applied in the clinical setting as part of the process of identifying and understanding gait disorders and fall risk. 2007 Movement Disorder Society
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              Falls and freezing of gait in Parkinson's disease: a review of two interconnected, episodic phenomena.

              Bastiaan Bloem, Jeffrey M. Hausdorff, Jasper E. Visser … (2004)
              Falls and freezing of gait are two "episodic" phenomena that are common in Parkinson's disease. Both symptoms are often incapacitating for affected patients, as the associated physical and psychosocial consequences have a great impact on the patients' quality of life, and survival is diminished. Furthermore, the resultant loss of independence and the treatment costs of injuries add substantially to the health care expenditures associated with Parkinson's disease. In this clinically oriented review, we summarise recent insights into falls and freezing of gait and highlight their similarities, differences, and links. Topics covered include the clinical presentation, recent ideas about the underlying pathophysiology, and the possibilities for treatment. A review of the literature and the current state-of-the-art suggests that clinicians should not feel deterred by the complex nature of falls and freezing of gait; a careful clinical approach may lead to an individually tailored treatment, which can offer at least partial relief for many affected patients. Copyright 2004 Movement Disorder Society
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                Author and article information

                Journal
                Journal ID (nlm-ta): Parkinsons Dis
                Journal ID (publisher-id): PD
                Title: Parkinson's Disease
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-8083
                ISSN (Electronic): 2042-0080
                Publication date (Print): 2012
                Publication date (Electronic): 15 January 2012
                Volume: 2012
                Electronic Location Identifier: 362572
                Affiliations
                1Unidad de Investigación en Trastornos del Movimiento, Instituto de Investigación Sanitaria Hospital Gregorio Marañón, 28007 Madrid, Spain
                2Servicio de Neurología, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo 46, 28007 Madrid, Spain
                Author notes
                *Francisco Grandas: fgrandasp@ 123456meditex.es

                Academic Editor: Jan O. Aasly

                Article
                DOI: 10.1155/2012/362572
                PMC ID: 3265111
                PubMed ID: 22292126
                SO-VID: 08972fc7-c7ad-4976-8ab4-be638b119da9
                Copyright © Copyright © 2012 A. Contreras and F. Grandas.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 2 August 2011
                Date revision received : 5 September 2011
                Date accepted : 23 September 2011
                Categories
                Subject: Clinical Study

                ScienceOpen disciplines: Neurology
                Data availability:
                ScienceOpen disciplines: Neurology

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