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. 2025 Apr:133:107328.
doi: 10.1016/j.parkreldis.2025.107328. Epub 2025 Feb 11.

Cognitive measures predict falls in Parkinson's disease: Insights from the CYCLE-II cohort

Saar Anis  1 , Eric Zimmerman  1 , A Elizabeth Jansen  2 , Ryan D Kaya  1 , Hubert H Fernandez  1 , Cielita Lopez-Lennon  3 , Leland E Dibble  3 , Anson B Rosenfeldt  2 , Jay L Alberts  4
Affiliations
Free article

Cognitive measures predict falls in Parkinson's disease: Insights from the CYCLE-II cohort

Saar Anis et al. Parkinsonism Relat Disord. 2025 Apr.
Free article

Abstract

Background: Accurate prediction of falls in patients with Parkinson's disease (PWP) is crucial for effective prevention efforts. Historically, fall risk models have heavily relied on motor features, overlooking the vital cognitive-motor interplay essential for locomotion.

Methods: Baseline assessments and year-long fall data from the CYClical Lower Extremity Exercise for Parkinson's disease II (CYCLE-II) trial's control group were utilized. A LASSO logistic regression model assessed thirty-seven demographic, motor, and cognitive variables to identify key fall predictors. To explore the practical implementation of predicting falls in a clinical setting, a second model was developed using a subset of nine candidate measures conducive for retrieval from electronic medical records. Models' accuracy was validated against Paul et al.'s 3-step fall prediction model.

Results: Analysis included 123 participants (mean age 65.3 ± 8.3 years, 66 % males, mean disease duration 4.9 ± 4.1 years). Seventy-two participants (58.5 %) fell at least once; with 33.1 % occurring during walking, 34.4 % resulting in injuries. The initial model identified 8 predictors with an AUC of 0.68. The second model, incorporating disease duration and cognitive tests, achieved an AUC of 0.67, comparable to Paul et al.'s validation (AUC 0.66). Participants with poorer information processing and spatial memory were more prone to falling over the 12-month period.

Conclusions: Impaired cognitive performance and longer disease duration were powerful predictors in identifying a future fall in PWP. The link between cognitive performance and potential for falling reinforces the strong interplay between gait and cognition.

Keywords: Falls prediction; Parkinson's disease; Processing speed; Spatial memory; Waiting room of the future.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jay L. Alberts reports financial support was provided by National Institute of Neurological Disorders and Stroke of the National Institutes of Health (NIH) under award number 2R01NS073717-06A1. Hubert H. Fernandez reports a relationship with Abbvie, Amneal, Cerevel, Neurocrine and Parkinson Study Group that includes: consulting or advisory. Dr. Fernandez has received honoraria from Abbvie, Amneal, Cerevel, Neurocrine and Parkinson Study Group as a consultant. Dr. Fernandez receives a stipend from Elsevier as the Editor-In-Chief of Parkinsonism and Related Disorders Journal. Dr. Fernandez has received royalty payments from Springer Publishing for serving as a book author/editor. The remaining authors declare no previous 12 months financial disclosures. Jay L. Alberts has authored intellectual property associated with the mobile cognitive and motor assessments If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.