ORIGINAL PAPER/ARTYKUŁ ORYGINALNYThe incidence and risk factors of falls in Parkinson disease: prospective studyCzęstość występowania i czynniki ryzyka upadków w chorobie Parkinsona: badanie prospektywne
Introduction
Falls are one of the most incapacitating features of Parkinson disease (PD), and occur in 38–68% of patients [1, 2, 3, 4]. As many as 25% of patients have two or more falls over 6 months [4]. Koller et al. [5] reported that approximately 13% of patients experienced falls at least once a week. In a majority of cases, falling begins at moderately advanced stages of PD, and as the disease progresses, the number of falls increases [6]. It was reported that falls can lead to an increased risk of mortality, morbidity and dependency in PD patients [7, 8]. For this reason falling is a serious problem and identification of risk factors is crucial for their prevention.
The retrospective studies identified some factors associated with falls in PD patients, including older age, longer duration of disease, more severe postural instability, bradykinesia and rigidity, frequent episodes of freezing, and the presence of autonomic dysfunction [9, 10]. To date, only a few prospective studies have considered the influence of selected factors on the risk of falls in PD [1, 2, 4, 11, 12, 13], and their results are not unequivocal. According to these studies, the following factors contribute to an increased frequency of falls: older age [11], longer duration of the disease [2, 11], greater severity of PD signs [1, 2, 4, 13, 14], the predominance of bradykinesia and muscle rigidity in the clinical picture [15, 16], the postural instability and gait disturbance subtype of PD [5, 17, 18], loss of arm swing [2], the presence of involuntary movements [19], coexisting dementia [2] and the presence of previous falls in the medical history [4]. In one study, polypharmacy and depression may also contribute to the occurrence of falls [1].
The aim of this study was to assess the incidence and risk factors for falls in a prospective study of patients with PD in comparison to healthy age-matched subjects.
Section snippets
Material and methods
Participation in the study was offered to all consecutive PD patients visiting the Movement Disorders Clinic, Neurology Department, University Hospital in Krakow, between February 2004 and February 2005. Inclusion criteria were: diagnosis of PD according to UK PD Society Brain Bank criteria [20], disease duration of at least 3 years, Hoehn and Yahr stage II-IV, and sustained, longer than one year, good response to levodopa therapy.
Exclusion criteria were: severe gait disability with inability
Statistical analysis
Categorical variables of patients and controls, and fallers and non-fallers were statistically assessed for association using the χ2 test and Fisher exact test. Normally distributed continuous variables were assessed using an independent samples t-test. The Mann-Whitney U-test was used for variables that were not normally distributed. In order to establish the risk factors for falls, logistic regression analysis was performed. Initially, several variables considered important for the occurrence
Results
One hundred out of the 106 patients with a diagnosis of idiopathic PD included in the study completed the 12-month follow-up. Of the six patients who dropped out of the study, three died, and three did not attend the follow-up visit. Fifty-six individuals were recruited to the control group. During follow-up, one person died and data from 55 controls were analysed.
Parkinson disease patients and the control group did not differ in terms of age (67.2 years vs. 65.5 years, p = 0.25) or gender
Discussion
The incidence of falls in PD patients (54%) found in this prospective observation is in the range of previously reported incidences (38–68%) studied in a prospective manner [1, 2, 4, 11, 13, 23, 24]. We also found a very similar percentage (49%) of fall incidence in the year preceding the observation period reported in anamnesis by patients or their caregivers. The authors of prospective studies who took into account the history of falls reported similar results; 39–64% of their patients
Acknowledgements
This study was supported with a grant received from the State Committee of Research (grant no. 3PO5B. 020.25).
Disclosure
Authors report no conflict of interest.
References (29)
- et al.
Cardiac responses to orthostatic stress deteriorate in Parkinson disease patients who begin to fall
Neurol Neurochir Pol
(2010) - et al.
A randomised controlled trial of a home based exercise program to reduce risk of falling among people with Parkinson's disease
J Neurol Neurosurg Psychiatry
(2007) - et al.
Incidence and prediction of falls in Parkinson's disease: a prospective multidisciplinary study
J Neurol Neurosurg Psychiatry
(2002) - et al.
Falls and injuries resulting from falls among patients with Parkinson's disease and other parkinsonian syndromes
Mov Disord
(2005) - et al.
Prospective assessment of falls in Parkinson's disease
J Neurol
(2001) - et al.
Falls and Parkinson's disease
Clin Neuropharmacol
(1989) - et al.
Sydney Multicenter Study of Parkinson's disease: non-L-dopa-responsive problems dominate at 15 years
Mov Disord
(2005) - et al.
Mortality and causes of death in idiopathic Parkinson's disease: results from the Aberdeen whole population study
Scott Med J
(1990) - et al.
Prevalence of parkinsonian signs and associated mortality in a community population of older people
N Engl J Med
(1996) - et al.
Falls in outpatients with Parkinson's disease. Frequency, impact and identifying factors
J Neurol
(2005)
Predictors of falls and fractures in bradykinetic rigid syndromes: a retrospective study
J Neurol Neurosurg Psychiatry
Fall risk factors in Parkinson's disease
J Neurosci Nurs
Predictors of future falls in Parkinson's disease
Neurology
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