Falls in Parkinson Disease

Falls are a major risk for Parkinson disease patients (PD). We sought to understand why patients fall. In one study we followed 404 PD patients for a year, 204 of who fell at least once. We did not distinguish between single and recurrent fallers. In a second study we followed 249 different patients for a year, 205 of whom fell once and 44 fell more than once (recurrent fallers). In the first study fallers were significantly older, 72.6 + 5.8 versus 66.9 + 6.1 years, had PD significantly longer 9.3 + 3.4 versus 5.4 + 2.2 years, had significantly higher (worse) motor Movement Disorder Society (MDS) Unified Parkinson Disease Rating Scale (UPDRS) scores 29.3 + 10.9 versus 18.9 + 8.3. Fallers walked with significantly shorter steps: 0.45 + 0.09 versus 0.60 + 0.13 m. Assessing step length, a simple “bedside” test, was a useful aid in predicting who might fall. In the second study recurrent fallers had PD significantly longer, 12.6 + 7.0 versus 5.9 + 4.5 years, had significantly higher motor MDS UPDRS scores 31.2 + 12.7 versus 19.7 + 8.3 and walked with significantly shorter steps: 0.37 + 0.18 m versus 0.52 + 0.19 m. A major difference between recurrent and single fallers was an inability of recurrent fallers to stand on one leg for <3 s: 95% versus 11%, odds ratio 178 CI 95% 39.5-801.2 Single fallers who are unable to stand on one leg for <3 s are at risk for recurrent falls. The short step, we believe, is an adaptation to postural instability, inability to maintain an upright position. The inability to stand on one leg, by depriving the patient of roughly half their proprioception, is a measure of risk for falls. Parkinson disease is viewed as a motor disorder, but impaired proprioception, a sensory symptom, is a major cause of recurrent falls. *Corresponding author: Abraham Lieberman, Founder, Muhammad Ali Parkinson Center, Director at Bob and Renee Parsons’ Fall Reduction Center, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA, Tel: +1-6024064309; E-mail: [email protected] Received May 26, 2016; Accepted July 11, 2016; Published July 18, 2016 Citation: Lieberman A, Deep A, Lockhart T (2016) Falls in Parkinson Disease. J Alzheimers Dis Parkinsonism 6: 248. doi: 10.4172/2161-0460.1000248 Copyright: © 2016 Lieberman A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. We analyzed 404 PD patients: 214 males, 190 females. All were examined every 4 months as part of their routine office visit. At each visit patients and care-givers were instructed to call us if they fell. Of the 404 persons with PD, 204, 50.5%, fell: 164 (80%) patients fell once, 41 fell (20%) more than once. We compared fallers with non-fallers. We analyzed serious falls where all 4 limbs, the skull or buttocks hit the ground, with patients sustaining a fracture or soft tissue injury. All patients were examined using the motor MDS UPDRS [17] and selected subtests. All patients were studied using the BNI balance scale [18]. This included the ability of a patient to stand on one leg for at least 3 s. All patients walked 7.63 m (25 feet). Adjustments were made for height, the number of steps taken was counted, divided by 7.63 m and an average was obtained. Next we did a second study 2011-2012 [19]. None of the patients were participants in the first study. We analyzed 205 patients: 113 men, 92 women of whom 161 (79%) fell once and 44 (21%) fell more than once. All patients were informed that the information collected could be used for research but that they personally could not be identified. Approval for the analysis Citation: Lieberman A, Deep A, Lockhart T (2016) Falls in Parkinson Disease. J Alzheimers Dis Parkinsonism 6: 248. doi: 10.4172/2161-0460.1000248