Predictors of future falls in Parkinson disease

TLDR

Falls are a major health problem for people with Parkinson disease, yet identifying predictors of fall risk remains unresolved. The study aimed to prospectively identify the best combination of functional and disease‑specific tests to predict falls in early‑stage Parkinson disease patients. Participants (n = 101) performed a battery of neurologic and functional tests—including Tinetti, Berg, Timed Up and Go, Functional Reach, and a comprehensive Physiological Profile Assessment—in their optimally medicated state, and falls were prospectively recorded over six months. A multivariate model combining UPDRS total score, freezing of gait, symptomatic postural orthostasis, Tinetti total score, and anterior‑posterior postural sway achieved 78 % sensitivity and 84 % specificity, with the rapid alternating task and deficits in peripheral sensation and knee extension strength emerging as key independent predictors, demonstrating that disease‑specific and balance‑mobility measures accurately forecast falls in early‑stage Parkinson disease.

Abstract

Falls are a major health and injury problem for people with Parkinson disease (PD). Despite the severe consequences of falls, a major unresolved issue is the identification of factors that predict the risk of falls in individual patients with PD. The primary aim of this study was to prospectively determine an optimal combination of functional and disease-specific tests to predict falls in individuals with PD.A total of 101 people with early-stage PD undertook a battery of neurologic and functional tests in their optimally medicated state. The tests included Tinetti, Berg, Timed Up and Go, Functional Reach, and the Physiological Profile Assessment of Falls Risk; the latter assessment includes physiologic tests of visual function, proprioception, strength, cutaneous sensitivity, reaction time, and postural sway. Falls were recorded prospectively over 6 months.Forty-eight percent of participants reported a fall and 24% more than 1 fall. In the multivariate model, a combination of the Unified Parkinson's Disease Rating Scale (UPDRS) total score, total freezing of gait score, occurrence of symptomatic postural orthostasis, Tinetti total score, and extent of postural sway in the anterior-posterior direction produced the best sensitivity (78%) and specificity (84%) for predicting falls. From the UPDRS items, only the rapid alternating task category was an independent predictor of falls. Reduced peripheral sensation and knee extension strength in fallers contributed to increased postural instability.Falls are a significant problem in optimally medicated early-stage PD. A combination of both disease-specific and balance- and mobility-related measures can accurately predict falls in individuals with PD.