BERLIN — More than 40 percent of
patients with patients with early Parkinson's disease reported falling, and not
surprisingly, a history of falls was a predictor of future ones, researches
reported here at the International Congress of Parkinson's Disease and Movement
Disorders meeting in June.
“Falling is a very serious problem
in Parkinson's disease,” said Kelvin Chou, MD, the Thomas and Susan C. Brown
Early Career professor of neurology at the University of Michigan in Ann Arbor.
“With this study, we wondered if we could identify people who fall early on in
their disease and try to understand the risk factors.”
Dr. Chou and his colleagues at
more than 12 centers around the country culled data from the NIH Exploratory
Trials in Parkinson's Disease LS-1 (NET-PD LS-1) study to determine how common falls
are and who was most at risk. The study, which was initially designed to test
the neuroprotective effects of the supplement, creatine, was halted in 2013
after an interim analysis determined that it did not slow progression of the
disease.
The scientists reviewed clinical
information from the study to assess how many of the 1,741 patients with early
Parkinson's disease reported a history of falling at baseline and then again
during follow-up assessments made three to six years later.
Study
subjects had to have been treated with dopaminergic agents for at least three
months and not more than two years. At baseline, 132 people reported a fall.
Three to six years later, 691 people (40 percent) said they had a fall since
their baseline assessment. Ninety-five of the 132 people (72 percent) who
reported a fall at the start of the study subsequently had another fall.
Among
the risk factors associated with falling were use of selective serotonin
reuptake inhibitors (SSRIs) and a patient's ambulatory capacity score, as
measured by the Unified Parkinson's Disease Rating Scale. In smaller numbers,
they also found that people who scored worse on the Total Functional Capacity
Scale, a test measuring general functional abilities, also had an increased
risk of falls.
Men had
a lower risk of falls, but there was an interaction of age by sex — men were
less likely to fall compared to women until age 80, after which they were more
likely to fall, said Dr. Chou. The odds of remaining fall-free were lowest in
those with a baseline lower ambulatory capacity score and male gender.
“This
study tells us that we really need to do more work to understand the risk
factors for falls,” Dr. Chou said. “It's hard because we don't know the exact
mechanism of falls in this population.”
EXPERTS
COMMENT
Graham
Kerr, PhD, professor of neuroscience at Queensland University of Technology in
Australia, who conducts research on falls, said: “Previous falls will predict
future falls, but that doesn't tell us about the physiology of what is going on
and why people are falling in the first place,” he said. His team has looked
for predictors and found that orthostatic hypotension plus a measure of
postural sway and a questionnaire on freezing have been helpful in predicting
future falls. They have also shown that people who fall have weaker muscles and
benefit from resistance training.
“This
study is important because the NET-PD cohort consisted of people with very
early Parkinson's disease,” said Michael S. Okun, MD, FAAN, the Adelaide
Lackner professor and chairman of neurology and co-director of the Movement
Disorders Center at the University of Florida in Gainesville. “Clinicians need
to be aware that just because patients are newly diagnosed, it does not mean
that they will not fall. Many practitioners are under the false impression that
there is nothing that can be done to prevent falling.”
“Early
identification of risk factors, medication optimization, and use of an
interdisciplinary team including physical and occupational therapists can
potentially reduce fall risk,” he added.
Fay
Horak, PhD, PT, director of the balance disorders laboratory and professor of
neurology at Oregon Health & Science University, added: “Falls are five
times more common in PD [than other neurodegenerative diseases], and this study
shows that they start very early in disease progression. It also found that
SSRI use predicted falls in these patients with early PD. This is new
information that could guide treatment decisions.”
http://journals.lww.com/neurotodayonline/Fulltext/2016/07210/News_from_the_International_Congress_of.12.aspx
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