Dyskinesia and FAB score predict future falling in Parkinson's disease

Abstract

Parkinson's disease (PD) is the world's second most common agerelated neurodegenerative disorder. Given the tendency for longer life expectancy and that the risk of PD increases with age, the number of people with PD is expected to double by the year 2030. 1 In PD, degeneration of the dopaminergic pathways results in striatal dopamine deficiency. The cardinal signs of disease are as follows:bradykinesia, muscle rigidity, resting tremor, and postural instability.In addition to these classic motor symptoms, non-motor features (eg, cognitive impairment, dizziness, and orthostatic hypotension) also occur. The core and first-choice therapy is dopaminergic medication (levodopa) that targets the neurotransmitter imbalance within the basal ganglia circuits. Complications of therapy such as dyskinesia (involuntary movements) and "off" periods (fluctuating drug response) often develop over time. 2 Falls and balance problems are common already in the early stages of disease 3,4 and progress over time. 5 A history of falls is the strongest predictor of future falls in PD. 6 However, it was suggested that prediction of both near falls and falls has greater clinical value than prediction of falls alone if you aim at working proactively. 7 Furthermore, fall prediction models, in order to be applicable, useful, and practical for routine clinical use, need to have sufficient discriminant ability 8,9 and must be easy to implement. 10 To this A growing body of research highlights the importance of cognition for prediction of falls in Parkinson's disease (PD). However, a previously proposed prediction model for future near falls and falls in PD, which includes history of near falls, tandem gait, and retropulsion, was developed without considering cognitive impairment.

Longitudinal prediction of falls and near falls frequencies in Parkinson’s disease: a prospective cohort study

“…In unselected populations, an average of 60.5% (35-90%) of persons with PD (PwPD) fell at least once over 12 months, with two-thirds being recurrent fallers [4]. Prospective studies have proposed numerous falls prediction models in PD [5][6][7][8][9][10]. The most robust predictor for future falls is a history of falls, whereas some observations suggest that a history of near falls has greater clinical value in terms of working proactively to avoid the occurrence of falls [6].…”

“…Furthermore, the previously proposed prediction models were derived to discriminate future fallers from non-fallers [5][6][7][8][9][10] and only a few studies investigated the impact of predictors on the frequency of falling [1,14,15]. To the best of our knowledge, no study has assessed predictors of the frequency of near falls.…”

Falls in Synucleinopathies

“…Other simple models, such as recent fall history, pull test, tandem gait and dyskinesias, and Frontal Assessment Battery (FAB), have also been examined. 35,36 Preemptively identifying modifiable risk factors to implement preventative strategies is essential. Over the past decade, many small to moderately sized prospective studies have attempted to elucidate this by comparing potential risk factor profiles between fallers and non-fallers ( Supplementary Table S1).…”

“…Other simple models, such as recent fall history, pull test, tandem gait and dyskinesias, and Frontal Assessment Battery (FAB), have also been examined. 35,36…”

Risk Factors Associated with Falls among Nursing Home Residents: A Case-Control Study

“…A reduction in their capacity to carry out the activities of dai-ly living can lead to a decrease in their physical strength due to a lack of muscle activity [11,13]. In addition, posture control and maintaining balance, mostly associated with cognitive changes in ageing, are also associated with falls [14][15][16][17][18][19]. Paresthesia, due to peripheral neuropathy or sensorial loss, produces several sudden sensations, which in turn can decrease motor and spatial perceptions, which ultimately results in falls [20,21].…”