TY - JOUR
T1 - What predicts falls in Parkinson disease?
T2 - Observations from the Parkinson's Foundation registry
AU - Parashos, Sotirios A.
AU - Bloem, Bastiaan R.
AU - Browner, Nina M.
AU - Giladi, Nir
AU - Gurevich, Tanya
AU - Hausdorff, Jeffrey M.
AU - He, Ying
AU - Lyons, Kelly E.
AU - Mari, Zoltan
AU - Morgan, John Christopher
AU - Post, Bart
AU - Schmidt, Peter N.
AU - Wielinski, Catherine L.
AU - Wu, Samuel S.
N1 - Funding Information:
a patent re: application on the use of virtual reality (submitted); the intellectual property rights are held by the Tel Aviv Medical Center; receives research support from European Commission, NIH, Michael J. Fox Foundation, NMMS, and BSF; and holds stock/stock options in Teva. Y. He reports no disclosures. K.E. Lyons serves on scientific advisory boards for Sage Therapeutics, St Jude Medical, and Acorda Therapeutics; is past CoEditor-in-Chief of the International Journal of Neuroscience; serves on the speakers’ bureau for ACADIA Pharmaceuticals; and serves on the National Parkinson Foundation Parkinson Outreach Project steering committee. Z. Mari serves as an Associate Editor for Parkinsonism and Related Disorders; serves as a consultant for GB Sciences; receives research support from AbbVie, Great Lakes Neurotechnology, Avid Radiopharmaceuticals, NIH (NHLBI, NINDS, National Parkinson Foundation, Johns Hopkins Parkinson’s Disease Center of Excellence, and Michael J. Fox Foundation; and has participated in medico-legal cases. J.C. Morgan has received speaker honoraria from Acadia, Impax, Neurocrine, National Parkinson Foundation, and Teva; serves as a consultant for AbbVie, Acadia, Adamas, Neurocrine, Parkinson’s Foundation, and Teva; serves on speakers’ bureaus for Acadia, Adamas, Impax, Parkinson’s Foundation, Neurocrine, and Teva; receives research support from AbbVie, Acorda, American College of Radiology, CHDI, Kyowa, Lilly, Lundbeck, Serina, US World Meds, VA Merit Review, National Parkinson Foundation, Parkinson’s Outcome Project Grant, and Parkinson’s Study Group; and has participated in medico-legal cases. B. Post reports no disclosures. P.N. Schmidt receives research support from National Parkinson Foundation and Parkinson’s Foundation. C.L. Wielinski reports no disclosures. S.S. Wu is author on a pending patent re: a computer-implemented method for preserving privacy for data collection, publication, and analysis; serves as a consultant for Bioness Inc.; and receives research support from NIH (NIMH, NINDS, NIA, NIAMS, NIGMS), US Department of Veterans Affairs, and US Army Department of Defense. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.
Publisher Copyright:
© © 2018 American Academy of Neurology.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Background We undertook this study to identify patients with Parkinson disease (PD) with no or rare falls who may progress to frequent falling by their next annual follow-up visit. Methods We analyzed data in the National Parkinson Foundation Quality Improvement Initiative database to identify factors predicting which patients with PD with no or rare falls at the baseline visit will report at least monthly falls at the annual follow-up visit. Multivariable models were constructed using logistic regression. Variables were introduced in 4 blocks: in the 1st block, variables present at or before the baseline visit were entered; in the 2nd, baseline visit assessments; in the 3rd, interventions implemented during baseline visit; and, in the 4th block, changes in comorbidities, living situation, and treatment between visits. Results Of 3,795 eligible participants, 3,276 (86.3%) reported no or rare falls at baseline visit, and of them, 382 (11.7%) reported at least monthly falls at follow-up visit. Predictors included female sex, <90% diagnostic certainty, motor fluctuations, levodopa treatment, antidepressant treatment, prior deep brain stimulation (DBS), worse quality of life, Hoehn & Yahr stage 2 or 3, worse semantic fluency, and, between visits, addition of amantadine, referral to occupational therapy, social services, or DBS, new diagnoses of cancer or osteoarthritis, and increased emergency visits. Conclusions This large-scale analysis identified several predictors of progression to falling in PD. Such identifiers may help target patient subgroups for falls prevention intervention. Some factors are modifiable, offering opportunities for developing such interventions.
AB - Background We undertook this study to identify patients with Parkinson disease (PD) with no or rare falls who may progress to frequent falling by their next annual follow-up visit. Methods We analyzed data in the National Parkinson Foundation Quality Improvement Initiative database to identify factors predicting which patients with PD with no or rare falls at the baseline visit will report at least monthly falls at the annual follow-up visit. Multivariable models were constructed using logistic regression. Variables were introduced in 4 blocks: in the 1st block, variables present at or before the baseline visit were entered; in the 2nd, baseline visit assessments; in the 3rd, interventions implemented during baseline visit; and, in the 4th block, changes in comorbidities, living situation, and treatment between visits. Results Of 3,795 eligible participants, 3,276 (86.3%) reported no or rare falls at baseline visit, and of them, 382 (11.7%) reported at least monthly falls at follow-up visit. Predictors included female sex, <90% diagnostic certainty, motor fluctuations, levodopa treatment, antidepressant treatment, prior deep brain stimulation (DBS), worse quality of life, Hoehn & Yahr stage 2 or 3, worse semantic fluency, and, between visits, addition of amantadine, referral to occupational therapy, social services, or DBS, new diagnoses of cancer or osteoarthritis, and increased emergency visits. Conclusions This large-scale analysis identified several predictors of progression to falling in PD. Such identifiers may help target patient subgroups for falls prevention intervention. Some factors are modifiable, offering opportunities for developing such interventions.
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U2 - 10.1212/CPJ.0000000000000461
DO - 10.1212/CPJ.0000000000000461
M3 - Article
AN - SCOPUS:85054006194
SN - 2163-0402
VL - 8
SP - 214
EP - 222
JO - Neurology: Clinical Practice
JF - Neurology: Clinical Practice
IS - 3
ER -