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. 2017 Nov;264(11):2268-2276.
doi: 10.1007/s00415-017-8620-y. Epub 2017 Sep 25.

Natural history of falls in an incident cohort of Parkinson's disease: early evolution, risk and protective features

Sue Lord  1   2   3 , Brook Galna  1 , Alison J Yarnall  1   2   4 , Rosie Morris  1   2 , Shirley Coleman  5 , David Burn  4   6 , Lynn Rochester  7   8   9
Affiliations

Natural history of falls in an incident cohort of Parkinson's disease: early evolution, risk and protective features

Sue Lord et al. J Neurol. 2017 Nov.

Abstract

The natural history of falls in early Parkinson's disease (PD) is poorly understood despite the profound effect of falls on outcome. The primary aim of this study was to describe the natural history of falls, and characterise fallers over 54 months in 99 newly diagnosed people with PD. Seventy-nine (79.7%) participants fell over 54 months and 20 (20.3%) remained falls-naïve. Twenty six (26.2%) reported retrospective falls at baseline. Gait outcomes, disease severity and self-efficacy significantly discriminated across groups. Subjective cognitive complaints emerged as the only significant cognitive predictor. Without exception, outcomes were better for non-fallers compared with fallers at any time point. Between group differences for 54 month fallers and non-fallers were influenced by the inclusion of retrospective fallers and showed a broader range of discriminant characteristics, notably stance time variability and balance self-efficacy. Single fallers (n = 7) were significantly younger than recurrent fallers (n = 58) by almost 15 years (P = 0.013). Baseline performance in early PD discriminates fallers over 54 months, thereby identifying those at risk of falls. Clinical profiles for established and emergent fallers are to some extent distinct. These results reiterate the need for timely interventions to improve postural control and gait.

Keywords: Characteristics; Falls; Parkinson’s disease; Prognosis.

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Conflict of interest statement

Conflicts of interest

The authors declare they have no conflict of interest.

Funding

Lynn Rochester’s research program is supported in part by grants from the Medical Research Council, European Union, Parkinson’s UK, EPSRC, the National Institute for Health Research Biomedical Research Unit for Lewy Body Dementias (NIHR BRU) and NIHR HTA. David Burn is supported by grants from Parkinson’s UK, MRC and Newcastle Healthcare Charity. Alison Yarnall is supported by Research Capability Funding and the Biomedical Research Centre. She has received honoraria from Teva-Lundbeck and sponsorship from Teva-Lundbeck, UCB, GlaxoSmithKline, Genus, Britannia, and Abb-Vie for attending conferences. Sue Lord, Brook Galna, Rosie Morris, and Shirley Coleman have nothing to declare.

Figures

Fig. 1
Fig. 1
Proportion of non-fallers over 54 months excluding retrospective fallers: a H&Y groups, b subjective cognitive complaint, c gait speed, and d stance time variability
See this image and copyright information in PMC

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