Schrag, A;
Choudhury, M;
Kaski, D;
Gallagher, DA;
(2015)
Why do patients with Parkinson's disease fall? A cross-sectional analysis of possible causes of falls.
npj Parkinson's Disease
, 1
, Article 15011. 10.1038/npjparkd.2015.11.
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Abstract
BACKGROUND: Falls in Parkinson's disease (PD) are associated with significant injury, disability, hospitalization, and reduced quality of life. AIMS: To identify modifiable medical causes of falls in a cohort of PD patients. METHODS: Eighty seven PD patients were interviewed and examined using validated scales assessing motor and nonmotor aspects of PD, comorbidities and medication use. The frequency of falls in the last month was the primary outcome measure. Falls were hypothesized to be associated with increasing age, advanced motor severity, particularly axial features (e.g., freezing and postural instability), and dyskinesia. Nonmotor features hypothesized to be associated with falls included; cognitive impairment, psychosis, sleep disorders, cardiovascular dysfunction, and ophthalmological and medical comorbidities. RESULTS: Fallers had longer disease duration, higher Levodopa-equivalent doses, greater 'On' time with dyskinesia (all P < 0.005), and higher scores on some Movement Disorder Society-Unified Parkinson's Disease Rating Scale items, particularly axial scores. However, patients with falls did not differ from non-fallers in age or overall motor UPDRS scores. Severity of psychosis, executive cognitive impairment, autonomic (particularly cardiovascular) dysfunction and sleep disturbances (particularly REM sleep behavioral disorder) were significantly associated with falls (all P < 0.005). Fallers more frequently reported use of antidepressants (both tricyclics and SSRIs) and neuroleptics (P < 0.001), but not hypnotics. There was no difference in medical comorbidities, ophthalmological assessments, fatigue, and apathy scores between the groups. In logistic regression analysis, cardiovascular dysfunction, antidepressant use, and REM sleep behavioral disorder were significantly associated with falls. CONCLUSIONS: The causes of falls in PD are multifactorial and extend beyond motor impairment and dyskinesia; addressing these in patients already treated with dopaminergic medications has the potential to improve this important complication of PD.
| Type: | Article |
|---|---|
| Title: | Why do patients with Parkinson's disease fall? A cross-sectional analysis of possible causes of falls. |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1038/npjparkd.2015.11 |
| Publisher version: | http://dx.doi.org/ 10.1038/npjparkd.2015.11 |
| Language: | English |
| Additional information: | Copyright © 2015 Parkinson's Disease Foundation/Macmillan Publishers Limited. This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/ by/4.0/ |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Movement Neurosciences |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1497679 |
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