News from the International Congress of Parkinson's Disease and Movement Disorders: Falls Occurs Often and Early in Parkinson's Disease, Study Finds

July 21, 2016

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