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Lang AE, Rodriguez RL, Boyd JT, Chouinard S, Zadikoff C, Espay AJ, Slevin JT, Fernandez HH, Lew MF, Stein DA, Odin P, Fung VS, Klostermann F, Fasano A, Draganov PV, Schmulewitz N, Robieson WZ, Eaton S, Chatamra K, Benesh JA, Dubow J. Integrated safety of levodopa-carbidopa intestinal gel from prospective clinical trials. Mov Disord 2015; 31:538-46. [PMID: 26695437 PMCID: PMC5064722 DOI: 10.1002/mds.26485] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 10/23/2015] [Accepted: 10/28/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Continuous administration of levodopa-carbidopa intestinal gel (carbidopa-levodopa enteral suspension) through a percutaneous endoscopic gastrojejunostomy is a treatment option for advanced Parkinson disease (PD) patients with motor fluctuations resistant to standard oral medications. Safety data from 4 prospective studies were integrated to assess the safety of this therapy. METHODS Safety data from 4 studies were summarized using 2 overlapping data sets, permitting the separation of procedure/device-associated (n = 395) from non-procedure/device adverse events (n = 412). RESULTS At the data cutoff, median exposure to levodopa-carbidopa intestinal gel was 911 days (range, 1-1980 days) with 963 total patient-years of exposure. Procedure/device adverse events occurred in 300 patients (76%), and serious adverse events occurred in 68 (17%); most frequently reported procedure/device adverse events and serious adverse events were complications of device insertion (41% and 8%, respectively) and abdominal pain (36% and 4%, respectively). Non-procedure/device adverse events occurred in 92% (379), with most frequently reported being insomnia (23%) and falls (23%); 42% (171) had non-procedure/device serious adverse events, with most frequently reported being pneumonia (5%) and PD symptoms (2%). Adverse events led to discontinuation in 17% (72), most frequently because of complication of device insertion (2.4%). There were 34 treatment-emergent deaths (8.3%) in the overlapping data sets, 2 of which (0.5%) were considered "possibly related" to the treatment system. CONCLUSION In the largest collection of levodopa-carbidopa intestinal gel safety data from prospective clinical studies, procedure/device events were frequently reported and occasionally life threatening. Most non-procedure/device events were typical for levodopa treatment and an elderly population. These factors combined with high treatment efficacy led to a relatively low discontinuation rate in advanced PD patients.
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Affiliation(s)
- Anthony E. Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | | | - James T. Boyd
- University of Vermont College of MedicineBurlingtonVermontUSA
| | | | - Cindy Zadikoff
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Alberto J. Espay
- University of Cincinnati Academic Health CenterCincinnatiOhioUSA
| | - John T. Slevin
- University of Kentucky Medical CenterLexingtonKentuckyUSA
| | | | - Mark F. Lew
- Keck/University of Southern California School of MedicineLos AngelesCaliforniaUSA
| | | | - Per Odin
- Klinikim‐BremerhavenGermany and Skane University HospitalLundSweden
| | | | | | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
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Effect of augmenting cholinergic function on gait and balance. BMC Neurol 2015; 15:264. [PMID: 26697847 PMCID: PMC4690312 DOI: 10.1186/s12883-015-0523-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/15/2015] [Indexed: 11/17/2022] Open
Abstract
Background Impaired mobility and falls are clinically important complications of Parkinson’s disease (PD) and a major detractor from quality of life for which there are limited therapies. Pathological, neuroimaging and clinical evidence suggest that degeneration of cholinergic systems may contribute to impairments of balance and gait in PD. The proposed trial will examine the effects of augmentation of the cholinergic system on balance and gait. Design The study is a single-site, proof of concept, randomized, double-blind, cross-over trial in patients with PD. Each treatment period will be 6 weeks with a 6-week washout between treatments for a total of 18 weeks for each subject. Donepezil in 2.5 mg capsules or identical appearing placebo capsules will be increased from two per day (5 mg) to four capsules (10 mg) after 3 weeks, if tolerated. Subjects will have idiopathic Parkinson’s disease, Hoehn and Yahr stages 2 to 4. We anticipate recruiting up to 100 subjects for screening to have 54 enrolled and 44 subjects complete both phases of treatment. Dropouts will be replaced. As this is a crossover trial, all subjects will be exposed to both donepezil and to placebo. The primary outcome measures will be the root mean square of the mediolateral sway when standing and the variability of the stride duration when walking for two minutes. Secondary outcomes will be the computerized Attention Network Test to examine three domains of attention and the Short-latency Afferent Inhibition (SAI), a physiological marker obtained with transcranial magnetic stimulation as a putative marker of cholinergic activity. Discussion The results of this study will be the most direct test of the hypothesized role of cholinergic neurotransmission in gait and balance. The study is exploratory because we do not know whether donepezil will affect gait, balance or attention, nor which measures of gait, balance or attention will be sensitive to drug manipulation. We hypothesize that change in cholinergic activity, as measured with SAI, will predict the relative effectiveness of donepezil on gait and balance. Our immediate goal is to determine the potential utility of cholinergic manipulation as a strategy for preventing or treating balance and gait dysfunction in PD. The findings of this trial are intended to lead to more sharply focused questions about the role of cholinergic neurotransmission in balance and gait and eventually to Phase II B trials to determine clinical utility of cholinergic manipulation to prevent falls and improve mobility. Trial registration This trial is registered at clinical trials.gov (NCT02206620).
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de Vries NM, Nonnekes J, Bloem BR. Toward affordable falls prevention in Parkinson's disease. Mov Disord 2015; 31:3-6. [PMID: 26660664 DOI: 10.1002/mds.26474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/07/2015] [Indexed: 11/09/2022] Open
Affiliation(s)
- Nienke M de Vries
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jorik Nonnekes
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
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Task- and Context-Specific Balance Training Program Enhances Dynamic Balance and Functional Performance in Parkinsonian Nonfallers: A Randomized Controlled Trial With Six-Month Follow-Up. Arch Phys Med Rehabil 2015; 96:2103-11. [DOI: 10.1016/j.apmr.2015.08.409] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/03/2015] [Accepted: 08/04/2015] [Indexed: 11/20/2022]
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Malochet-Guinamand S, Durif F, Thomas T. Parkinson's disease: A risk factor for osteoporosis. Joint Bone Spine 2015; 82:406-10. [DOI: 10.1016/j.jbspin.2015.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 03/11/2015] [Indexed: 10/23/2022]
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Sakushima K, Yamazaki S, Fukuma S, Hayashino Y, Yabe I, Fukuhara S, Sasaki H. Influence of urinary urgency and other urinary disturbances on falls in Parkinson's disease. J Neurol Sci 2015; 360:153-7. [PMID: 26723992 DOI: 10.1016/j.jns.2015.11.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/23/2015] [Accepted: 11/28/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Falling is one of the most common and serious public health problems. It can cause injuries such as sprains and fractures, and hospitalization may be required for serious injuries. Patients with Parkinson's disease have a higher risk of falls, and urinary incontinence is a known risk factor for falls in the elderly. However, whether other urinary disturbances contribute to the risk of falling remains unclear. The purpose of this study was to identify the association between falls and urinary disturbances in Parkinson's disease. METHODS A prospective cohort study was conducted at a single institution with a 6-month observation period. Subjects were ambulatory patients with Parkinson's disease. Assessments included patient demographics, disease severity measured by the Hoehn and Yahr scale, and urinary disturbances measured using the overactive bladder symptom score (OABSS). Falls were reported using a self-documented fall record. RESULTS A total of 97 patients were included. Forty-four subjects experienced one or more falls during the observation period. The frequency of urination was not related to falling; however, mild urinary urgency, but not severe urinary urgency, increased the risk of falls by an odds ratio of 5.14 (95% confidence interval: 1.51-17.48). Mild urinary urgency was also associated with the time to the first fall and the frequency of falls. One third of falls occurred in the living room, and 13.8% of falls occurred on the way to/from the toilet. CONCLUSION Falls in patients with Parkinson's disease might be associated with urinary urgency, but not with the frequency of urination.
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Affiliation(s)
- Ken Sakushima
- Department of Neurology, Hokkaido University Graduate School of Medicine, Japan.
| | - Shin Yamazaki
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Japan
| | - Shingo Fukuma
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Japan; Center for Innovative Research for Community and Clinical Excellence, Fukushima Medical University, Japan
| | - Yasuaki Hayashino
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Japan
| | - Ichiro Yabe
- Department of Neurology, Hokkaido University Graduate School of Medicine, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Japan; Center for Innovative Research for Community and Clinical Excellence, Fukushima Medical University, Japan
| | - Hidenao Sasaki
- Department of Neurology, Hokkaido University Graduate School of Medicine, Japan
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Brandmeir NJ, Brandmeir CL, Kuzma K, McInerney J. A Prospective Evaluation of an Outpatient Assessment of Postural Instability to Predict Risk of Falls in Patients with Parkinson's Disease Presenting for Deep Brain Stimulation. Mov Disord Clin Pract 2015; 3:151-155. [PMID: 30713907 DOI: 10.1002/mdc3.12257] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 08/04/2015] [Accepted: 08/08/2015] [Indexed: 11/11/2022] Open
Abstract
Background Postural instability (PI) and falls, major causes of morbidity in patients with PD, are often overlooked. DBS is a mainstay therapy for Parkinson's disease (PD) and has been purported to both worsen and improve PI. An effective PI evaluation that can predict fall risk in patients with PD presenting for DBS is needed. Methods Forty-nine consecutive patients with PD were enrolled. Self-reported falls were the gold standard. Tests evaluated were the Berg Balance Scale (BBS), Timed-Up-and-Go (TUG), Pull Test, and Biodex Balance System Sway Index on firm (SI-FIRM) and soft (SI-SOFT) surfaces. Results The best single tests for fall risk were the BBS and SI-FIRM, each with sensitivities of 79% and specificities of 60% and 65%, respectively. When the evaluation was combined into a composite measure requiring four positive tests out of five, the sensitivity was 72% and specificity was 80%. Conclusions A simple, efficient outpatient physical therapy assessment is effective in diagnosing fall risk in patients with PD.
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Affiliation(s)
- Nicholas J Brandmeir
- Department of Neurosurgery Penn State Milton S. Hershey Medical Center Hershey Pennsylvania USA
| | - Cheryl L Brandmeir
- Department of Therapy Services Penn State Milton S. Hershey Medical Center Hershey Pennsylvania USA
| | - Kristine Kuzma
- Department of Neurosurgery Penn State Milton S. Hershey Medical Center Hershey Pennsylvania USA
| | - James McInerney
- Department of Neurosurgery Penn State Milton S. Hershey Medical Center Hershey Pennsylvania USA
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Duncan RP, Leddy AL, Cavanaugh JT, Dibble LE, Ellis TD, Ford MP, Foreman KB, Earhart GM. Detecting and predicting balance decline in Parkinson disease: a prospective cohort study. JOURNAL OF PARKINSONS DISEASE 2015; 5:131-9. [PMID: 25514984 DOI: 10.3233/jpd-140478] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The natural progression of balance decline in individuals with Parkinson disease (PD) is not well understood. OBJECTIVES We aimed to: 1) compare the utility of three standardized clinical measures for detecting balance decline over 1-year, 2) identify components of balance susceptible to decline, and 3) identify factors useful for predicting future balance decline. METHODS Eighty people with PD (59% male; mean age 68.2 ± 9.3; Hoehn & Yahr range I-IV) completed Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Berg Balance Scale (BBS) assessments. Baseline predictor variables included the MDS-UPDRS III sub-score, presence of freezing, 6-month fall history, age, gender, and physical activity. Balance and MDS-UPDRS III assessments were repeated at 6 (n = 51) and 12 months (n = 44). RESULTS BESTest and Mini-BESTest score declined over 6 and 12 months (P < 0.01). Postural responses, stability limits, and sensory orientation were most susceptible to decline. BBS score did not change (P > 0.01). MDS-UPDRS III score was unchanged over 6 months (P > 0.01), but declined over 12 months (P < 0.01). Change in BESTest score over 6 months was related to baseline MDS-UPDRS III, H&Y, freezing, and fall history (P < 0.05). Change in BESTest score over 12 months was related to baseline MDS-UPDRS III and freezing (P < 0.05). Change in Mini-BESTest over 12 months was related to baseline MDS-UPDRS III and age (P < 0.05). CONCLUSIONS The BESTest and Mini-BESTest were responsive to balance decline in individuals with PD and helped to identify decline in underlying balance components. Disease severity and freezing most consistently predicted balance decline in persons with PD.
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Affiliation(s)
- Ryan P Duncan
- Washington University in St. Louis School of Medicine, Program in Physical Therapy, MO, USA Department of Neurology, Washington University in St. Louis School of Medicine, MO, USA
| | - Abigail L Leddy
- Rehabilitation Hospital of the Pacific, Department of Physical Therapy, HI, USA
| | | | | | - Terry D Ellis
- Department of Physical Therapy and Athletic Training, Boston University, MA, USA
| | - Matthew P Ford
- Department of Physical Therapy, Samford University, AL, USA
| | - K Bo Foreman
- Department of Physical Therapy, University of Utah, UT, USA
| | - Gammon M Earhart
- Washington University in St. Louis School of Medicine, Program in Physical Therapy, MO, USA Department of Anatomy & Neurobiology, Washington University in St. Louis School of Medicine, MO, USA Department of Neurology, Washington University in St. Louis School of Medicine, MO, USA
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Can postural instability tests improve the prediction of future falls in people with Parkinson's disease beyond knowing existing fall history? J Neurol 2015; 263:133-9. [PMID: 26530511 DOI: 10.1007/s00415-015-7950-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Abstract
This study sought to determine whether the backward-stepping Push and Release (P&R) Test and the Pull Test, or comprehensive batteries of postural instability (the Mini-BESTest and Brief-BESTest), significantly improve the prediction of future falls beyond knowing a person's baseline fall history. Complete data were available for 43 of 80 participants with PD. At baseline, participants completed the BESTest (which was scored for all versions and includes the P&R Test), the Unified PD Rating Scale (UPDRS) motor section (which includes the Pull Test), and the participants' reported falls experienced in the previous 6 months. Participants were classified as recurrent fallers if they reported more than one fall in the 12 months subsequent to baseline. Stepwise logistic regressions determined whether the P&R Test, Pull Test, Brief-BESTest, Mini-BESTest, or UPDRS motor score improved predictions of recurrent fallers independent of baseline fall-group status. Independently, all assessments significantly predicted future recurrent fallers, but only the Mini-BESTest and Brief-BESTest significantly improved predictions of future recurrent fallers independent of baseline fall-group status. The results suggest that, although single tests of reactive postural control do not offer significant predictive benefit, predictions of future recurrent fallers with PD do benefit from a balance examination in addition to knowing whether an individual has a recent history of falls.
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211
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Martinez-Ramirez D, Giugni JC, Almeida L, Walz R, Ahmed B, Chai FA, Rundle-Gonzalez V, Bona AR, Monari E, Wagle Shukla A, Hess CW, Hass CJ, Okun MS. Association between antidepressants and falls in Parkinson’s disease. J Neurol 2015; 263:76-82. [DOI: 10.1007/s00415-015-7947-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 11/27/2022]
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Predicting Falls in Parkinson Disease: What Is the Value of Instrumented Testing in OFF Medication State? PLoS One 2015; 10:e0139849. [PMID: 26443998 PMCID: PMC4596567 DOI: 10.1371/journal.pone.0139849] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/17/2015] [Indexed: 11/20/2022] Open
Abstract
Background Falls are a common complication of advancing Parkinson's disease (PD). Although numerous risk factors are known, reliable predictors of future falls are still lacking. The objective of this prospective study was to investigate clinical and instrumented tests of balance and gait in both OFF and ON medication states and to verify their utility in the prediction of future falls in PD patients. Methods Forty-five patients with idiopathic PD were examined in defined OFF and ON medication states within one examination day including PD-specific clinical tests, instrumented Timed Up and Go test (iTUG) and computerized dynamic posturography. The same gait and balance tests were performed in 22 control subjects of comparable age and sex. Participants were then followed-up for 6 months using monthly fall diaries and phone calls. Results During the follow-up period, 27/45 PD patients and 4/22 control subjects fell one or more times. Previous falls, fear of falling, more severe motor impairment in the OFF state, higher PD stage, more pronounced depressive symptoms, higher daily levodopa dose and stride time variability in the OFF state were significant risk factors for future falls in PD patients. Increased stride time variability in the OFF state in combination with faster walking cadence appears to be the most significant predictor of future falls, superior to clinical predictors. Conclusion Incorporating instrumented gait measures into the baseline assessment battery as well as accounting for both OFF and ON medication states might improve future fall prediction in PD patients. However, instrumented testing in the OFF state is not routinely performed in clinical practice and has not been used in the development of fall prevention programs in PD. New assessment methods for daylong monitoring of gait, balance and falls are thus required to more effectively address the risk of falling in PD patients.
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213
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Gervasoni E, Cattaneo D, Messina P, Casati E, Montesano A, Bianchi E, Beghi E. Clinical and stabilometric measures predicting falls in Parkinson disease/parkinsonisms. Acta Neurol Scand 2015; 132:235-41. [PMID: 25690532 DOI: 10.1111/ane.12388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Clinical predictors of falls in patients with Parkinson disease (PD) are fairly inaccurate. Stabilometric measures appear useful in investigating the relationship between balance, sensory disturbance, and falls. The aim of the study was to identify the best combination of clinical and stabilometric tests to predict falls prospectively. MATERIALS & METHODS Fifty-three consecutive subjects with PD or parkinsonisms at risk of falls were included and followed for 6 months. Clinical variables were used as fall predictors: the Unified Parkinson Disease's Rating Scale (motor section) and the Longitudinal Aging study Amsterdam Physical Activity Questionnaire (LAPAQ). Variables from stabilometric platform underwent a principal component analysis. Multivariate logistic models were used to predict fallers using fall status (fallers: 1 + falls; recurrent fallers: 2 + falls) as dependent variable. RESULTS Seven patients were lost to follow up, leaving 46 evaluable subjects. Of these, 32 (70%) were fallers and 22 (48%) were recurrent fallers. The only variable predicting fallers was the LAPAQ (odd ratio [OR] 0.99 (95% confidence interval [CI] 0.98-1.00); accuracy 71.7%; sensitivity 87.5%; specificity 35.7%). For recurrent fallers, Factor 2 (body sway velocity) (OR 2.37; 95% CI 1.01-5.58) and, in part, LAPAQ (OR 0.99; 95% CI 0.98-1.00) retained significance in the multivariate model, showing an accuracy of 76.9%, a sensitivity of 77.8%, and a specificity of 76.2%. CONCLUSIONS A combination of clinical and instrumental tools is useful to identify fallers in PD or parkinsonisms. Body sway velocity and ability to perform the activities of daily living are the best predictors of recurrent falls.
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Affiliation(s)
- E. Gervasoni
- LaRiCE: Gait and Balance Disorders Laboratory Department of Neurorehabilitation; Don Gnocchi Foundation I.R.C.C.S; Milan Italy
| | - D. Cattaneo
- LaRiCE: Gait and Balance Disorders Laboratory Department of Neurorehabilitation; Don Gnocchi Foundation I.R.C.C.S; Milan Italy
| | - P. Messina
- Laboratory of Neurological Disorders; IRCCS - Mario Negri Institute for Pharmacological Research Via La Masa; Milan Italy
| | - E. Casati
- LaRiCE: Gait and Balance Disorders Laboratory Department of Neurorehabilitation; Don Gnocchi Foundation I.R.C.C.S; Milan Italy
| | - A. Montesano
- LaRiCE: Gait and Balance Disorders Laboratory Department of Neurorehabilitation; Don Gnocchi Foundation I.R.C.C.S; Milan Italy
| | - E. Bianchi
- Laboratory of Neurological Disorders; IRCCS - Mario Negri Institute for Pharmacological Research Via La Masa; Milan Italy
| | - E. Beghi
- Laboratory of Neurological Disorders; IRCCS - Mario Negri Institute for Pharmacological Research Via La Masa; Milan Italy
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The Parkinsonian Gait Spatiotemporal Parameters Quantified by a Single Inertial Sensor before and after Automated Mechanical Peripheral Stimulation Treatment. PARKINSONS DISEASE 2015; 2015:390512. [PMID: 26495152 PMCID: PMC4606184 DOI: 10.1155/2015/390512] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/05/2015] [Accepted: 09/02/2015] [Indexed: 11/18/2022]
Abstract
This study aims to evaluate the change in gait spatiotemporal parameters in subjects with Parkinson's disease (PD) before and after Automated Mechanical Peripheral Stimulation (AMPS) treatment. Thirty-five subjects with PD and 35 healthy age-matched subjects took part in this study. A dedicated medical device (Gondola) was used to administer the AMPS. All patients with PD were treated in off levodopa phase and their gait performances were evaluated by an inertial measurement system before and after the intervention. The one-way ANOVA for repeated measures was performed to assess the differences between pre- and post-AMPS and the one-way ANOVA to assess the differences between PD patients and the control group. Spearman's correlations assessed the associations between patients with PD clinical status (H&Y) and the percentage of improvement of the gait variables after AMPS (α < 0.05 for all tests). The PD group had an improvement of 14.85% in the stride length; 14.77% in the gait velocity; and 29.91% in the gait propulsion. The correlation results showed that the higher the H&Y classification, the higher the stride length percentage of improvement. The treatment based on AMPS intervention seems to induce a better performance in the gait pattern of PD patients, mainly in intermediate and advanced stages of the condition.
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Stuckenschneider T, Helmich I, Raabe-Oetker A, Froböse I, Feodoroff B. Active assistive forced exercise provides long-term improvement to gait velocity and stride length in patients bilaterally affected by Parkinson's disease. Gait Posture 2015; 42:485-90. [PMID: 26319218 DOI: 10.1016/j.gaitpost.2015.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 07/28/2015] [Accepted: 08/03/2015] [Indexed: 02/02/2023]
Abstract
Forced exercise training presents a valid method of improving symptoms of Parkinson's disease such as rigor, dyskinesia and gait dysfunctions. Brain imaging data suggest that use of active assistive forced exercise could improve Parkinsonian symptoms more effectively than passive assistive forced exercise. However, the long-term effects of active versus passive assistive forced exercise on the symptoms of Parkinson's disease are unknown. Here, 24 patients showing bilateral effects of Parkinson's disease underwent a 12 week intervention of either passive or active assistive forced exercise. We analyzed tremor scores, gait patterns, and scores on the Unified Parkinson's Disease Rating Scale-III from three timepoints--before beginning the intervention, upon completion of the intervention, and twelve weeks after completion of the intervention. Participation in both passive and active assistive forced exercise increased gait velocity (0.5 km/h), swing phase (2%), monopedal stance phase (2%), elongated stride length (11 cm) and decreased double stance phase (4%). However, with participation in active assistive forced exercise, postural and kinetic tremor were also reduced and gait velocity and stride length were increased long-term. Given these findings, we conclude that future treatment for patients bilaterally affected by Parkinson's disease should carefully consider the type of assistive forced exercise intervention to be used.
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Affiliation(s)
- T Stuckenschneider
- Institute of Health Promotion and Clinical Movement Science, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany.
| | - I Helmich
- Department of Neurology, Psychosomatic Medicine and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - A Raabe-Oetker
- Department of Neurology, Psychosomatic Medicine and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - I Froböse
- Institute of Health Promotion and Clinical Movement Science, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - B Feodoroff
- Institute of Health Promotion and Clinical Movement Science, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
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McVey MA, Barnds AN, Lyons KE, Pahwa R, Mahnken JD, Luchies CW. The characterization of a base-width neutral step as the first step for balance recovery in moderate Parkinson's disease. Int J Neurosci 2015; 126:713-22. [PMID: 26371386 DOI: 10.3109/00207454.2015.1094472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this study is to characterize the base-width neutral step (BNS) as the first step in a compensatory step response in persons with moderate Parkinson's disease (PD), and its effect on balance recovery. MATERIALS AND METHODS Ten PD and 10 healthy controls (HCs) responded to a posterior waist pull. A BNS was defined if the first step was less than 50 mm. The length, height, duration and velocity of the BNS and its effect on balance recovery time and center of mass location at recovery were compared to the first step within other stepping strategies (single step (SS), multiple step (MS)). A linear mixed model was used to compare across strategies. RESULTS Six of ten persons with PD compared to zero HC used a BNS. The BNS was shorter in length and duration compared to MS responses in HC, and shorter in duration compared to MS responses in PD. The BNS was slower in velocity compared to every other strategy. BNS use resulted in a longer recovery time compared to all strategies in HC and SS responses in PD, and trended toward a longer recovery time compared to MS responses in PD. CONCLUSIONS The BNS as the first step in a MS response may be an unreported strategy for compensatory stepping in PD. This study suggests that the cost of utilizing the BNS may be a longer time for recovery, but further work is necessary to understand the progression of the BNS as PD severity increases.
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Affiliation(s)
- Molly A McVey
- a 1 Department of Mechanical Engineering , University of Kansas , Lawrence, Kansas , KS , USA
| | - Annaria N Barnds
- b 2 Bioengineering, University of Kansas , Lawrence, Kansas , KS , USA
| | - Kelly E Lyons
- c 3 Department of Neurology , University of Kansas Medical Center , Kansas City , KS , USA
| | - Rajesh Pahwa
- c 3 Department of Neurology , University of Kansas Medical Center , Kansas City , KS , USA
| | - Jonathan D Mahnken
- d 4 Department of Biostatistics , University of Kansas Medical Center , Kansas City , KS , USA
| | - Carl W Luchies
- a 1 Department of Mechanical Engineering , University of Kansas , Lawrence, Kansas , KS , USA.,b 2 Bioengineering, University of Kansas , Lawrence, Kansas , KS , USA
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217
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Park JH, Kang YJ, Horak FB. What Is Wrong with Balance in Parkinson's Disease? J Mov Disord 2015; 8:109-14. [PMID: 26413237 PMCID: PMC4572660 DOI: 10.14802/jmd.15018] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/19/2015] [Accepted: 06/22/2015] [Indexed: 11/24/2022] Open
Abstract
Postural instability and resulting falls are major factors determining quality of life, morbidity, and mortality in individuals with Parkinson’s disease (PD). A better understanding of balance impairments would improve management of balance dysfunction and prevent falls in patients with PD. The effects of bradykinesia, rigidity, impaired proprioception, freezing of gait and attention on postural stability in patients with idiopathic PD have been well characterized in laboratory studies. The purpose of this review is to systematically summarize the types of balance impairments contributing to postural instability in people with PD.
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Affiliation(s)
- Jeong-Ho Park
- Department of Neurology, College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Yeo-Jeong Kang
- Department of Neurology, College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Fay Bahling Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA ; Portland VA Medical Center, Portland, OR, USA
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218
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Cancela J, Fico G, Arredondo Waldmeyer MT. Using the Analytic Hierarchy Process (AHP) to understand the most important factors to design and evaluate a telehealth system for Parkinson's disease. BMC Med Inform Decis Mak 2015; 15 Suppl 3:S7. [PMID: 26391847 PMCID: PMC4705498 DOI: 10.1186/1472-6947-15-s3-s7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The assessment of a new health technology is a multidisciplinary and multidimensional process, which requires a complex analysis and the convergence of different stakeholders into a common decision. This task is even more delicate when the assessment is carried out in early stage of development processes, when the maturity of the technology prevents conducting a large scale trials to evaluate the cost effectiveness through classic health economics methods. This lack of information may limit the future development and deployment in the clinical practice. This work aims to 1) identify the most relevant user needs of a new medical technology for managing and monitoring Parkinson's Disease (PD) patients and to 2) use these user needs for a preliminary assessment of a specific system called PERFORM, as a case study. METHODS Analytic Hierarchy Process (AHP) was used to design a hierarchy of 17 needs, grouped into 5 categories. A total of 16 experts, 6 of them with a clinical background and the remaining 10 with a technical background, were asked to rank these needs and categories. RESULTS On/Off fluctuations detection, Increase wearability acceptance, and Increase self-management support have been identified as the most relevant user needs. No significant differences were found between the clinician and technical groups. These results have been used to evaluate the PERFORM system and to identify future areas of improvement. CONCLUSIONS First of all, the AHP contributed to the elaboration of a unified hierarchy, integrating the needs of a variety of stakeholders, promoting the discussion and the agreement into a common framework of evaluation. Moreover, the AHP effectively supported the user need elicitation as well as the assignment of different weights and priorities to each need and, consequently, it helped to define a framework for the assessment of telehealth systems for PD management and monitoring. This framework can be used to support the decision-making process for the adoption of new technologies in PD.
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Affiliation(s)
- Jorge Cancela
- Life Supporting Technologies, Universidad Politecnica de Madrid, ETSI Telecomunicación, Ciudad Universitaria, Madrid, Spain
| | - Giuseppe Fico
- Life Supporting Technologies, Universidad Politecnica de Madrid, ETSI Telecomunicación, Ciudad Universitaria, Madrid, Spain
| | - Maria T Arredondo Waldmeyer
- Life Supporting Technologies, Universidad Politecnica de Madrid, ETSI Telecomunicación, Ciudad Universitaria, Madrid, Spain
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219
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Abstract
Postural instability is a key feature of Parkinson Disease that is associated with falls and morbidity. We designed a pull apparatus to quantitatively measure the force needed to pull subjects off-balance. Thirteen Controls and eight individuals with Parkinson Disease (PD) were evaluated. All individuals with PD reported subjective symptoms of postural instability and were symptomatic for approximately 9.4years when tested. No significant differences were found between Controls and PD subjects in the magnitude of force required to pull them off-balance. None of the Controls fell and all took a step into the direction of pull to maintain their balance. 59% of the time PD subjects fell because they did not take a step in the direction of pull to maintain their center of mass (COM) over their feet, thus indicating a deficiency in postural reflexes. If they fell on the first pull, PD subjects did not show a learning effect when pulled multiple times in the same direction. The utility of the Pull Test to detect postural instability is related to the subject's behavioral response, not the force needed to pull them off balance. Our findings may also help explain certain features of the PD gait as an attempt by subjects to avoid postural instability by not placing their COM in gravitationally unstable positions.
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Affiliation(s)
- Kristopher Kimmell
- Department of Neurology, VA Medical Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Vinay K Pulusu
- Department of Neurology, VA Medical Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kersi J Bharucha
- Department of Neurology, VA Medical Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Elliott D Ross
- Department of Neurology, VA Medical Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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220
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St George RJ, Carlson-Kuhta P, King LA, Burchiel KJ, Horak FB. Compensatory stepping in Parkinson's disease is still a problem after deep brain stimulation randomized to STN or GPi. J Neurophysiol 2015; 114:1417-23. [PMID: 26108960 DOI: 10.1152/jn.01052.2014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 06/19/2015] [Indexed: 11/22/2022] Open
Abstract
The effects of deep brain stimulation (DBS) on balance in people with Parkinson's disease (PD) are not well established. This study examined whether DBS randomized to the subthalamic nucleus (STN; n = 11) or globus pallidus interna (GPi; n = 10) improved compensatory stepping to recover balance after a perturbation. The standing surface translated backward, forcing subjects to take compensatory steps forward. Kinematic and kinetic responses were recorded. PD-DBS subjects were tested off and on their levodopa medication before bilateral DBS surgery and retested 6 mo later off and on DBS, combined with off and on levodopa medication. Responses were compared with PD-control subjects (n = 8) tested over the same timescale and 17 healthy control subjects. Neither DBS nor levodopa improved the stepping response. Compensatory stepping in the best-treated state after surgery (DBS+DOPA) was similar to the best-treated state before surgery (DOPA) for the PD-GPi group and the PD-control group. For the PD-STN group, there were more lateral weight shifts, a delayed foot-off, and a greater number of steps required to recover balance in DBS+DOPA after surgery compared with DOPA before surgery. Within the STN group five subjects who did not fall during the experiment before surgery fell at least once after surgery, whereas the number of falls in the GPi and PD-control groups were unchanged. DBS did not improve the compensatory step response needed to recover from balance perturbations in the GPi group and caused delays in the preparation phase of the step in the STN group.
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Affiliation(s)
- R J St George
- Department of Neurology, Oregon Health and Science University, Beaverton, Oregon; Human Motor Control Laboratory, School of Medicine, University of Tasmania, Hobart, Australia
| | - P Carlson-Kuhta
- Department of Neurology, Oregon Health and Science University, Beaverton, Oregon
| | - L A King
- Department of Neurology, Oregon Health and Science University, Beaverton, Oregon
| | - K J Burchiel
- Department of Neurosurgery, Oregon Health and Science University, Beaverton, Oregon
| | - F B Horak
- Department of Neurology, Oregon Health and Science University, Beaverton, Oregon; Department of Veterans Affairs Portland Health Care System, Portland, Oregon; and
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221
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Kataoka H, Ueno S. Low FAB score as a predictor of future falling in patients with Parkinson's disease: a 2.5-year prospective study. J Neurol 2015; 262:2049-55. [PMID: 26076741 DOI: 10.1007/s00415-015-7814-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 06/03/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
Abstract
Falling is one of the most disabling features of Parkinson's disease (PD). Many cross-sectional studies, case-control studies, and prospective studies have attempted to identify risk factors or predictors of falls, but consistent results are yet to be obtained because of the various factors involved. We prospectively studied patients with various severities of PD to identify risk factors for future falls during 2.5 years of follow-up. We registered 95 patients with PD, and 83 patients were included in data analysis. A total of 23 variables were evaluated by multivariate logistic regression analysis. Thirty-one patients (37%) had a previous history of falling, and 26 patients (30%) experienced their first fall. The prevalence of falls at 2.5 years was 62% (52 of 83 patients). Frontal Assessment Battery (FAB) score (OR 1.393, p = 0.005, 95% CI 1.104-1.759) and history of fall present (OR 0.142, p = 0.002, 95% CI 0.042-0.48) were related to falling on multiple logistic regression analysis. The following variables differed significantly between patients with first falls and those without falling: levodopa equivalent dose (p = 0.023), UPDRS part I (p = 0.006), SF-8 (p = 0.017), and FAB (p = 0.026). Calculation of the FAB score may be useful for predicting the risk of future falls in patients with various severities of PD. Our results suggest that a low FAB score combined with a history of falling within the past 6 months carries an increased risk of future falls.
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Affiliation(s)
- Hiroshi Kataoka
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Satoshi Ueno
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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222
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Why do patients with Parkinson's disease fall? A cross-sectional analysis of possible causes of falls. NPJ PARKINSONS DISEASE 2015; 1:15011. [PMID: 28409181 PMCID: PMC5388183 DOI: 10.1038/npjparkd.2015.11] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Falls in Parkinson’s disease (PD) are associated with significant injury, disability, hospitalization, and reduced quality of life. Aims: To identify modifiable medical causes of falls in a cohort of PD patients. Methods: Eighty seven PD patients were interviewed and examined using validated scales assessing motor and nonmotor aspects of PD, comorbidities and medication use. The frequency of falls in the last month was the primary outcome measure. Falls were hypothesized to be associated with increasing age, advanced motor severity, particularly axial features (e.g., freezing and postural instability), and dyskinesia. Nonmotor features hypothesized to be associated with falls included; cognitive impairment, psychosis, sleep disorders, cardiovascular dysfunction, and ophthalmological and medical comorbidities. Results: Fallers had longer disease duration, higher Levodopa-equivalent doses, greater ‘On’ time with dyskinesia (all P<0.005), and higher scores on some Movement Disorder Society-Unified Parkinson’s Disease Rating Scale items, particularly axial scores. However, patients with falls did not differ from non-fallers in age or overall motor UPDRS scores. Severity of psychosis, executive cognitive impairment, autonomic (particularly cardiovascular) dysfunction and sleep disturbances (particularly REM sleep behavioral disorder) were significantly associated with falls (all P<0.005). Fallers more frequently reported use of antidepressants (both tricyclics and SSRIs) and neuroleptics (P<0.001), but not hypnotics. There was no difference in medical comorbidities, ophthalmological assessments, fatigue, and apathy scores between the groups. In logistic regression analysis, cardiovascular dysfunction, antidepressant use, and REM sleep behavioral disorder were significantly associated with falls. Conclusions: The causes of falls in PD are multifactorial and extend beyond motor impairment and dyskinesia; addressing these in patients already treated with dopaminergic medications has the potential to improve this important complication of PD.
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223
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Huang YF, Cherng YG, Hsu SPC, Yeh CC, Chou YC, Wu CH, Chen TL, Liao CC. Risk and adverse outcomes of fractures in patients with Parkinson's disease: two nationwide studies. Osteoporos Int 2015; 26:1723-32. [PMID: 25672807 DOI: 10.1007/s00198-015-3052-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/27/2015] [Indexed: 01/10/2023]
Abstract
UNLABELLED The association between Parkinson's disease and fracture was not completely understood. This nationwide study investigated increased risk of fracture in patients with Parkinson's disease. In the nested cohort study, Parkinson's disease was associated with pneumonia, septicemia, stroke, urinary tract infection, and mortality after fracture admission. INTRODUCTION Falls are a common complication in people with Parkinson's disease (PD). This study evaluated fracture risk and post-fracture outcomes in patients with PD. METHODS We identified 1,423 adults aged 40 years and older newly diagnosed with PD using the Taiwan National Health Insurance Research Database from 2000 to 2003. Comparison cohort consisted of 5,692 adults without PD randomly selected from the same dataset, frequency matched in age and sex. Followed-up events of fracture from January 1, 2000, until December 31, 2008, were ascertained from medical claims. Adjusted hazard ratios (HR) and 95 % confidence interval (CI) of fracture associated with PD were evaluated. Another nested cohort study of 397,766 hospitalized fracture patients analyzed for adjusted odds ratios (ORs) and 95 % CIs of adverse events after fracture among patients with and without PD between 2004 and 2010. RESULTS The incidences of fracture for people with and without PD were 39.5 and 23.9 per 1,000 person-years, respectively (p < 0.0001). Compared with control, the adjusted HR of fracture was 2.25 (95 % CI 1.97-2.58) for PD patients. Previous PD was associated with risks of pneumonia (OR 1.44, 95 % CI 1.36-1.52), septicemia (OR 1.41, 95 % CI 1.33-1.49), stroke (OR 1.40, 95 % CI 1.32-1.50), urinary tract infection (OR 1.53, 95 % CI 1.46-1.61), and mortality (OR 1.25, 95 % CI 1.15-1.35) after fracture. CONCLUSIONS PD was associated with higher risk of fracture. Patients with PD had more complications and mortality after fracture. Fracture prevention and attention to post-fracture adverse events are needed for this susceptible population.
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Affiliation(s)
- Y-F Huang
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Y-G Cherng
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - S P C Hsu
- Neurosurgery Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Visiting Professor, Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - C-C Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Y-C Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
| | - C-H Wu
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - T-L Chen
- School of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Medical University Hospital, 252 Wuxing St., Taipei, Taiwan, 110
- Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - C-C Liao
- School of Medicine, Taipei Medical University, Taipei, Taiwan.
- Department of Anesthesiology, Taipei Medical University Hospital, 252 Wuxing St., Taipei, Taiwan, 110.
- Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.
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224
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Wong-Yu IS, Mak MK. Multi-dimensional balance training programme improves balance and gait performance in people with Parkinson's disease: A pragmatic randomized controlled trial with 12-month follow-up. Parkinsonism Relat Disord 2015; 21:615-21. [DOI: 10.1016/j.parkreldis.2015.03.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/11/2015] [Accepted: 03/22/2015] [Indexed: 11/29/2022]
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225
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Falls in ambulatory non-demented patients with Parkinson's disease. J Neural Transm (Vienna) 2015; 122:1447-55. [PMID: 25845678 DOI: 10.1007/s00702-015-1396-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
Abstract
This study aimed at determining the prevalence of falling in PD patients, to assess generic and disease-specific clinical and pharmacological factors, relationship with health-related quality of life (HR-QoL) and changes in falls from OFF to ON in patients with motor fluctuations. Six-hundred and eighty-three PD patients of the COPARK survey were evaluated (11 had missing data and were excluded from the analysis). Patients with falls were identified as those with a UPDRS Item 13 ≥ 1 in the ON condition. All patients were assessed in a standardized manner [demographics, treatments, Unified PD Rating Scale (UPDRS), Hospital Anxiety and Depression Scale, Pittsburg questionnaire and HR-QoL scales (SF36, PDQ39)]. Falling was reported by 108/672 (16%) PD patients during the ON state and prevalence increased according to PD severity, from 5% in Hoehn and Yahr stage 1-60% in stage 4. Falling was significantly related to lower HR-QoL. Falling correlated with (1) generic factors such as female gender, age at the end of academic studies and diuretics consumption, (2) motor PD-specific factors including disease severity, frozen gait, difficulties when arising from a chair, dyskinesia and higher levodopa daily equivalent dose and (3) non-motor PD-specific factors such as orthostatic hypotension and hallucinations. Falling was more frequent in OFF than in ON in 48/74 (64%) patients with motor fluctuations and remained unchanged in 27 patients (36%). In summary, falling affected a significant proportion of PD patients, especially in advanced stages. It was associated with a variety of generic and PD-specific factors and was related to reduced HR-QoL.
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226
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Ozinga SJ, Machado AG, Miller Koop M, Rosenfeldt AB, Alberts JL. Objective assessment of postural stability in Parkinson's disease using mobile technology. Mov Disord 2015; 30:1214-21. [PMID: 25809137 DOI: 10.1002/mds.26214] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/09/2015] [Accepted: 02/26/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A significant gap remains in the ability to effectively characterize postural instability in individuals with Parkinson's disease. Clinical evaluation of postural declines is largely subjective, whereas objective biomechanical approaches are expensive and time consuming, thus limiting clinical adoption. Recent advances in mobile devices present an opportunity to address the gap in the quantification of postural stability. The aim of this project was to determine whether kinematic data measured by hardware within a tablet device, a 3rd generation iPad, was of sufficient quantity and quality to characterize postural stability. METHODS Seventeen patients and 17 age-matched controls completed six balance conditions under altered surface, stance, and vision. Simultaneous kinematic measurements were gathered from a three-dimensional motion capture system and tablet. RESULTS The motion capture system and tablet provided similar measures of stability across groups. In particular, within the patient population, correlation between the two systems for peak-to-peak, normalized path length, root mean square, 95% volume, and total power values ranged from 0.66 to 1.00. Kinematic data from five balance conditions--double-leg stance with eyes open on a foam surface, double-leg stance with eyes closed on firm and foam surfaces, and tandem stance on firm and foam surfaces--were capable of discriminating patients from controls. CONCLUSIONS The hardware within the tablet provides data of sufficient accuracy for the quantification of postural stability in patients with Parkinson's disease. The objectivity, portability, and ease of use of this device make it ideal for use in clinical environments lacking sophisticated biomechanical systems.
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Affiliation(s)
- Sarah J Ozinga
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, Ohio, USA
| | - Andre G Machado
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mandy Miller Koop
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anson B Rosenfeldt
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
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227
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Moreno Catalá M, Woitalla D, Arampatzis A. Recovery performance and factors that classify young fallers and non-fallers in Parkinson's disease. Hum Mov Sci 2015; 41:136-46. [PMID: 25816793 DOI: 10.1016/j.humov.2015.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/22/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Abstract
Postural instability is a major problem for Parkinson's disease patients (PDs). Identifying the causes of postural instability at a young age would contribute to the development of adequate training interventions aiming to reduce falls. The purpose of this study was to investigate the effect of muscle strength and balance ability on dynamic stability control after simulated disturbances and to develop an applicable tool able to classify young PDs into fallers and non-fallers. Twenty-five young PDs (12 fallers, 13 non-fallers, 48±5 yrs.) and 14 healthy controls participated in the study. Dynamic stability was examined during simulated forward falls. Muscle strength was assessed by isometric maximal plantarflexion and knee extension contractions. Balance ability was evaluated by measuring the anterior and posterior limits of stability (LoS). The fallers showed lower recovery performance in forward falls and lower muscle strength compared to controls. Muscle strength and anterior LoS were significantly associated to stability performance. These two factors could correctly classify 90% of PD fallers, establishing an accurate assessment tool to predict the falling risk in young PDs. Furthermore, muscle strength partly explained recovery performance; therefore, we can argue that young PDs with an increased falling risk may benefit from leg-extensors strengthening and stability training.
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Affiliation(s)
- María Moreno Catalá
- Department of Training and Movement Sciences, Humboldt-University Berlin, Philippstr. 13, 10115 Berlin, Germany.
| | - Dirk Woitalla
- Department of Neurology, St. Joseph Hospital, Ruhr-University, Gudrunstr. 56, 44791 Bochum, Germany.
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-University Berlin, Philippstr. 13, 10115 Berlin, Germany.
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228
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Tillman A, Muthalib M, Hendy AM, Johnson LG, Rantalainen T, Kidgell DJ, Enticott PG, Teo WP. Lower limb progressive resistance training improves leg strength but not gait speed or balance in Parkinson's disease: a systematic review and meta-analysis. Front Aging Neurosci 2015; 7:40. [PMID: 25852550 PMCID: PMC4371754 DOI: 10.3389/fnagi.2015.00040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/10/2015] [Indexed: 12/03/2022] Open
Abstract
The use of progressive resistance training (PRT) to improve gait and balance in people with Parkinson’s disease (PD) is an emerging area of interest. However, the main effects of PRT on lower limb functions such as gait, balance, and leg strength in people with PD remain unclear. Therefore, the aim of the meta-analysis is to evaluate the evidence surrounding the use of PRT to improve gait and balance in people with PD. Five electronic databases, from inception to December 2014, were searched to identify the relevant studies. Data extraction was performed by two independent reviewers and methodological quality was assessed using the PEDro scale. Standardized mean differences (SMD) and 95% confidence intervals (CIs) of fixed and random effects models were used to calculate the effect sizes between experimental and control groups and I2 statistics were used to determine levels of heterogeneity. In total, seven studies were identified consisting of 172 participants (experimental n = 84; control n = 88). The pooled results showed a moderate but significant effect of PRT on leg strength (SMD 1.42, 95% CI 0.464–2.376); however, no significant effects were observed for gait speed (SMD 0.418, 95% CI −0.219 to 1.055). No significant effects were observed for balance measures included in this review. In conclusion, our results showed no discernable effect of PRT on gait and balance measures, although this is likely due to the lack of studies available. It may be suggested that PRT be performed in conjunction with balance or task-specific functional training to elicit greater lower limb functional benefits in people with PD.
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Affiliation(s)
- Alex Tillman
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University , Burwood, VIC , Australia
| | - Makii Muthalib
- Movement to Health (M2H) Laboratory, Euromov, University of Montpellier , Montpellier , France
| | - Ashlee M Hendy
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University , Burwood, VIC , Australia
| | - Liam G Johnson
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne , Heidelberg, VIC , Australia ; Institute of Sport, Exercise, and Active Living (ISEAL), Victoria University , Melbourne, VIC , Australia
| | - Timo Rantalainen
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University , Burwood, VIC , Australia
| | - Dawson J Kidgell
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University , Melbourne, VIC , Australia
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University , Burwood, VIC , Australia
| | - Wei-Peng Teo
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University , Burwood, VIC , Australia
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229
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Incidence and prediction of falls in Parkinson’s disease: a prospective cohort study. Eur J Epidemiol 2015; 30:349-52. [DOI: 10.1007/s10654-015-0019-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/10/2015] [Indexed: 11/26/2022]
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230
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Canning CG, Allen NE, Bloem BR, Keus SHJ, Munneke M, Nieuwboer A, Sherrington C, Verheyden GSAF. Interventions for preventing falls in Parkinson's disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011574] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Colleen G Canning
- University of Sydney; Clinical and Rehabilitation Sciences Research Group - Faculty of Health Sciences; PO Box 170 Lidcombe NSW Australia 1825
| | - Natalie E Allen
- University of Sydney; Clinical and Rehabilitation Sciences Research Group - Faculty of Health Sciences; PO Box 170 Lidcombe NSW Australia 1825
| | - Bastiaan R Bloem
- Radboud University Nijmegen Medical Center; Department of Neurology; PO Box 9101 Nijmegen Netherlands 6500 HB
| | - Samyra HJ Keus
- Radboud University Nijmegen Medical Center; Department of Neurology; PO Box 9101 Nijmegen Netherlands 6500 HB
| | - Marten Munneke
- Radboud University Nijmegen Medical Center; Department of Neurology; PO Box 9101 Nijmegen Netherlands 6500 HB
| | - Alice Nieuwboer
- KU Leuven; Department of Rehabilitation Sciences; Tervuursevest 101, Postbus 1501 Leuven Belgium 3001
| | - Catherine Sherrington
- The George Institute for Global Health, Sydney Medical School, University of Sydney; Musculoskeletal Division; PO Box M201 Missenden Road Sydney NSW Australia 2050
| | - Geert SAF Verheyden
- KU Leuven; Department of Rehabilitation Sciences; Tervuursevest 101, Postbus 1501 Leuven Belgium 3001
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The relationship between real world ambulatory activity and falls in incident Parkinson's disease: Influence of classification scheme. Parkinsonism Relat Disord 2015; 21:236-42. [DOI: 10.1016/j.parkreldis.2014.12.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/30/2014] [Accepted: 12/16/2014] [Indexed: 11/15/2022]
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232
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Morgan P, McDonald R, McGinley J. Perceived cause, environmental factors, and consequences of falls in adults with cerebral palsy: a preliminary mixed methods study. Rehabil Res Pract 2015; 2015:196395. [PMID: 25802759 PMCID: PMC4352903 DOI: 10.1155/2015/196395] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 02/03/2015] [Accepted: 02/09/2015] [Indexed: 11/18/2022] Open
Abstract
Objective. Describe perceived cause, environmental influences, and consequences of falls or near-falls in ambulant adults with cerebral palsy (CP). Methods. Adults with CP completed postal surveys and follow-up semistructured interviews. Surveys sought information on demographic data, self-nominated Gross Motor Function Classification Score (GMFCS-E&R), falls, and near-falls. Interviews gathered additional information on falls experiences, near-falls, and physical and psychosocial consequences. Results. Thirty-four adults with CP participated. Thirty-three participants reported at least one fall in the previous year. Twenty-six participants reported near-falls. Most commonly, falls occurred indoors, at home, and whilst engaged in nonhazardous ambulation. Adults with CP experienced adverse falls consequences, lower limb injuries predominant (37%), and descriptions of fear, embarrassment, powerlessness, and isolation. Discussion. Adults with CP may experience injurious falls. Further investigation into the impact of falls on health-related quality of life and effective remediation strategies is warranted to provide comprehensive falls prevention programs for this population.
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Affiliation(s)
- Prue Morgan
- Department of Physiotherapy, School of Primary Health Care, Monash University, Frankston, VIC 3199, Australia
| | - Rachael McDonald
- Department of Occupational Therapy, School of Primary Health Care, Monash University, Frankston, VIC 3199, Australia
| | - Jennifer McGinley
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
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Vinik AI, Vinik EJ, Colberg SR, Morrison S. Falls Risk in Older Adults with Type 2 Diabetes. Clin Geriatr Med 2015; 31:89-99, viii. [DOI: 10.1016/j.cger.2014.09.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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234
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Conradsson D, Löfgren N, Nero H, Hagströmer M, Ståhle A, Lökk J, Franzén E. The Effects of Highly Challenging Balance Training in Elderly With Parkinson's Disease: A Randomized Controlled Trial. Neurorehabil Neural Repair 2015; 29:827-36. [PMID: 25608520 PMCID: PMC4582836 DOI: 10.1177/1545968314567150] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background. Highly challenging exercises have been suggested to induce neuroplasticity in individuals with Parkinson’s disease (PD); however, its effect on clinical outcomes remains largely unknown. Objective. To evaluate the short-term effects of the HiBalance program, a highly challenging balance-training regimen that incorporates both dual-tasking and PD-specific balance components, compared with usual care in elderly with mild to moderate PD. Methods. Participants with PD (n = 100) were randomized, either to the 10-week HiBalance program (n = 51) or to the control group (n = 49). Participants were evaluated before and after the intervention. The main outcomes were balance performance (Mini-BESTest), gait velocity (during normal and dual-task gait), and concerns about falling (Falls Efficacy Scale–International). Performance of a cognitive task while walking, physical activity level (average steps per day), and activities of daily living were secondary outcomes. Results. A total of 91 participants completed the study. After the intervention, the between group comparison showed significantly improved balance and gait performance in the training group. Moreover, although no significant between group difference was observed regarding gait performance during dual-tasking; the participants in the training group improved their performance of the cognitive task while walking, as compared with the control group. Regarding physical activity levels and activities of daily living, in comparison to the control group, favorable results were found for the training group. No group differences were found for concerns about falling. Conclusions. The HiBalance program significantly benefited balance and gait abilities when compared with usual care and showed promising transfer effects to everyday living. Long-term follow-up assessments will further explore these effects.
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Affiliation(s)
- David Conradsson
- Karolinska Institutet, Stockholm, Sweden Karolinska University Hospital, Stockholm, Sweden
| | | | - Håkan Nero
- Karolinska Institutet, Stockholm, Sweden
| | - Maria Hagströmer
- Karolinska Institutet, Stockholm, Sweden Karolinska University Hospital, Stockholm, Sweden
| | - Agneta Ståhle
- Karolinska Institutet, Stockholm, Sweden Karolinska University Hospital, Stockholm, Sweden
| | - Johan Lökk
- Karolinska Institutet, Stockholm, Sweden Karolinska University Hospital, Stockholm, Sweden
| | - Erika Franzén
- Karolinska Institutet, Stockholm, Sweden Karolinska University Hospital, Stockholm, Sweden
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235
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Dual tasking with the timed "up & go" test improves detection of risk of falls in people with Parkinson disease. Phys Ther 2015; 95:95-102. [PMID: 25147186 DOI: 10.2522/ptj.20130386] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Falls are a common and disabling feature of Parkinson disease (PD). Early identification of patients at greatest risk of falling is a key goal of physical therapy assessment. The Timed "Up & Go" Test (TUG), a frequently used mobility assessment tool, has moderate sensitivity and specificity for identifying fall risk. OBJECTIVE The study objective was to investigate whether adding a task (cognitive or manual) to the TUG (TUG-cognitive or TUG-manual, respectively) increases the utility of the test for identifying fall risk in people with PD. DESIGN This was a retrospective cohort study of people with PD (N=36). METHODS Participants were compared on the basis of self-reported fall exposure in the preceding 6 months (those who had experienced falls ["fallers"] versus those who had not ["nonfallers"]). The time taken to complete the TUG, TUG-cognitive, and TUG-manual was measured for both groups. Between-group differences were calculated with the Mann-Whitney U test. The discriminative performance of the test at various cutoff values was examined, and estimates of sensitivity and specificity were based on receiver operating characteristic curve plots. RESULTS Fallers took significantly longer than nonfallers (n=19) to complete the TUG under all 3 conditions. The TUG-cognitive showed optimal discriminative performance (receiver operating characteristic area under the curve=0.82; 95% confidence interval [CI]=0.64, 0.92) at a cutoff of 14.7 seconds. The TUG-cognitive was more likely to correctly classify participants with a low risk of falling (positive likelihood ratio=2.9) (<14.7 seconds) and had higher estimates of sensitivity (0.76; 95% CI=0.52, 0.90) than of specificity (0.73; 95% CI=0.51, 0.88) at this threshold (negative likelihood ratio=0.32). LIMITATIONS Retrospective classification of fallers and nonfallers was used. CONCLUSIONS The addition of a cognitive task to the TUG enhanced the identification of fall risk in people with PD. The TUG-cognitive should be considered a component of a multifaceted fall risk assessment in people with PD.
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Amar K, Stack E, Fitton C, Ashburn A, Roberts H. Fall frequency, predicting falls and participating in falls research: Similarities among people with Parkinson's disease with and without cognitive impairment. Parkinsonism Relat Disord 2015; 21:55-60. [DOI: 10.1016/j.parkreldis.2014.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/31/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
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Leiknes I, Lien UT, Severinsson E. The Relationship among Caregiver Burden, Demographic Variables, and the Clinical Characteristics of Patients with Parkinson’s Disease—A Systematic Review of Studies Using Various Caregiver Burden Instruments. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojn.2015.510091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rittenhouse KJ, To T, Rogers A, Wu D, Horst M, Edavettal M, Miller JA, Rogers FB. Hyponatremia as a fall predictor in a geriatric trauma population. Injury 2015; 46:119-23. [PMID: 25065652 DOI: 10.1016/j.injury.2014.06.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 05/16/2014] [Accepted: 06/13/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Approximately one in three older adults fall each year, resulting in a significant proportion of geriatric traumatic injuries. In a hospital with a focus on geriatric fall prevention, we sought to characterize this population to develop targeted interventions. As mild hyponatremia, defined as a serum sodium <135meq/L, has been reported to be associated with falls, unsteadiness and attention deficits, we hypothesized that hyponatremia is associated with falls in our geriatric trauma population. METHODS Gender, age, pre-existing conditions (cardiac disease, diabetes, hematologic disorder, liver disease, malignancy, musculoskeletal disorder, neurological disorder, obesity, psychiatric disorder, pulmonary disease, renal disease, thyroid disease), mechanism of injury and admitting serum sodium level were queried for all geriatric trauma admissions from 2008 to 2011. Mechanism of injury was coded as falls admissions and non-falls admissions. Admitting serum sodium levels were coded as hyponatremic (<135mmol/L) and not hyponatremic (≥135mmol/L). RESULTS Of the 2370 geriatric trauma admissions during the study period, there were 1841 (77.7%) falls admissions and 293 (12.4%) patients who were hyponatremic. Gender, age, neurological disorder, hematologic disorder, and hyponatremia were found to be significant predictors of falls in both univariate and multivariable analyses. CONCLUSION Hyponatremic patients are significantly more likely to be admitted for a fall than non-hyponatremic patients, when adjusting for age, neurological disorder, and hematologic disorder. Consequently, hyponatremia identification and management should be an integral part of any geriatric trauma fall prevention programme. Additionally, if hyponatremia is found during a geriatric fall workup, it should be corrected prior to discharge and closely monitored by a primary care physician to prevent recurrent episodes of falls.
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Affiliation(s)
| | - Tuc To
- Lancaster General Health, Lancaster, PA, United States
| | - Amelia Rogers
- Lancaster General Health, Lancaster, PA, United States
| | - Daniel Wu
- Lancaster General Health, Lancaster, PA, United States
| | - Michael Horst
- Lancaster General Health, Lancaster, PA, United States
| | | | - Jo Ann Miller
- Lancaster General Health, Lancaster, PA, United States
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239
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Liao YY, Yang YR, Cheng SJ, Wu YR, Fuh JL, Wang RY. Virtual Reality-Based Training to Improve Obstacle-Crossing Performance and Dynamic Balance in Patients With Parkinson's Disease. Neurorehabil Neural Repair 2014; 29:658-67. [PMID: 25539782 DOI: 10.1177/1545968314562111] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Obstacle crossing is a balance-challenging task and can cause falls in people with Parkinson's disease (PD). However, programs for people with PD that effectively target obstacle crossing and dynamic balance have not been established. OBJECTIVE To examine the effects of virtual reality-based exercise on obstacle crossing performance and dynamic balance in participants with PD. METHODS Thirty-six participants with a diagnosis of PD (Hoehn and Yahr score ranging 1 to 3) were randomly assigned to one of three groups. In the exercise groups, participants received virtual reality-based Wii Fit exercise (VRWii group) or traditional exercise (TE group) for 45 minutes, followed by 15 minutes of treadmill training in each session for a total of 12 sessions over 6 weeks. Participants in the control group received no structured exercise program. Primary outcomes included obstacle crossing performance (crossing velocity, stride length, and vertical toe obstacle clearance) and dynamic balance (maximal excursion, movement velocity, and directional control measured by the limits-of-stability test). Secondary outcomes included sensory organization test (SOT), Parkinson's Disease Questionnaire (PDQ39), fall efficacy scale (FES-I), and timed up and go test (TUG). All outcomes were assessed at baseline, after training, and at 1-month follow-up. RESULTS The VRWii group showed greater improvement in obstacle crossing velocity, crossing stride length, dynamic balance, SOT, TUG, FES-I, and PDQ39 than the control group. VRWii training also resulted in greater improvement in movement velocity of limits-of-stability test than TE training. CONCLUSIONS VRWii training significantly improved obstacle crossing performance and dynamic balance, supporting implementation of VRWii training in participants with PD.
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Affiliation(s)
- Ying-Yi Liao
- Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan National Yang-Ming University, Taipei, Taiwan
| | - Yea-Ru Yang
- National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jung Cheng
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yih-Ru Wu
- Department of Neurology, Chang-Gung Memorial Hospital, Linkou, Taiwan Chang-Gung University College of Medicine, Linkou, Taiwan
| | - Jong-Ling Fuh
- National Yang-Ming University, Taipei, Taiwan Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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Boonstra TA, Schouten AC, van Vugt JPP, Bloem BR, van der Kooij H. Parkinson's disease patients compensate for balance control asymmetry. J Neurophysiol 2014; 112:3227-39. [DOI: 10.1152/jn.00813.2013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In Parkinson's disease (PD) subtle balance abnormalities can already be detected in early-stage patients. One feature of impaired balance control in PD is asymmetry: one leg produces more corrective joint torque than the other. We hypothesize that in mild to moderately affected PD patients, the least impaired leg compensates for the more impaired leg. Twenty PD patients and eleven healthy matched control subjects participated. Clinical asymmetry was determined by the difference between the left and right body side scores on the Unified Parkinson's Disease Rating Scale. Balance was perturbed with two independent continuous multisine perturbations in the forward-backward direction. Subsequently, we applied closed-loop system identification, which determined the spectral estimate of the stabilizing mechanisms, for each leg. Balance control behavior was similar in PD patients and control subjects at the ankle, but at the hip stiffness was increased. Control subjects exhibited symmetric balance control, but in PD patients the balance contribution of the leg of the clinically least affected body side was higher whereas the leg of the clinically most affected body side contributed less. The ratio between the legs helped to preserve a normal motor output at the ankle. Our results suggest that PD patients compensate for balance control asymmetries by increasing the relative contribution of the leg of their least affected body side. This compensation appears to be successful at the ankle but is accompanied by an increased stiffness at the hip. We discuss the possible implications of these findings for postural stability and fall risk in PD patients.
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Affiliation(s)
- T. A. Boonstra
- Department of Biomechanical Engineering, University of Twente, MIRA Institute for Biomechanical Technology and Technical Medicine, Enschede, The Netherlands
| | - A. C. Schouten
- Department of Biomechanical Engineering, University of Twente, MIRA Institute for Biomechanical Technology and Technical Medicine, Enschede, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - J. P. P. van Vugt
- Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands; and
| | - B. R. Bloem
- Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - H. van der Kooij
- Department of Biomechanical Engineering, University of Twente, MIRA Institute for Biomechanical Technology and Technical Medicine, Enschede, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
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Deane KHO, Flaherty H, Daley DJ, Pascoe R, Penhale B, Clarke CE, Sackley C, Storey S. Priority setting partnership to identify the top 10 research priorities for the management of Parkinson's disease. BMJ Open 2014; 4:e006434. [PMID: 25500772 PMCID: PMC4281559 DOI: 10.1136/bmjopen-2014-006434] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/14/2014] [Accepted: 11/18/2014] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES This priority setting partnership was commissioned by Parkinson's UK to encourage people with direct and personal experience of the condition to work together to identify and prioritise the top 10 evidential uncertainties that impact on everyday clinical practice for the management of Parkinson's disease (PD). SETTING The UK. PARTICIPANTS Anyone with experience of PD including: people with Parkinson's (PwP), carers, family and friends, healthcare and social care professionals. Non-clinical researchers and employees of pharmaceutical or medical devices companies were excluded. 1000 participants (60% PwP) provided ideas on research uncertainties, 475 (72% PwP) initially prioritised them and 27 (37% PwP) stakeholders agreed a final top 10. METHODS Using a modified nominal group technique, participants were surveyed to identify what issues for the management of PD needed research. Unique research questions unanswered by current evidence were identified and participants were asked to identify their top 10 research priorities from this list. The top 26 uncertainties were presented to a consensus meeting with key stakeholders to agree the top 10 research priorities. RESULTS 1000 participants provided 4100 responses, which contained 94 unique unanswered research questions that were initially prioritised by 475 participants. A consensus meeting with 27 stakeholders agreed the top 10 research priorities. The overarching research aspiration was an effective cure for PD. The top 10 research priorities for PD management included the need to address motor symptoms (balance and falls, and fine motor control), non-motor symptoms (sleep and urinary dysfunction), mental health issues (stress and anxiety, dementia and mild cognitive impairments), side effects of medications (dyskinesia) and the need to develop interventions specific to the phenotypes of PD and better monitoring methods. CONCLUSIONS These research priorities identify crucial gaps in the existing evidence to address everyday practicalities in the management of the complexities of PD.
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Affiliation(s)
| | - Helen Flaherty
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - David J Daley
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Roland Pascoe
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Bridget Penhale
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Carl E Clarke
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham, UK
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Abstract
Osteoporosis is a skeletal disease characterized by decreased bone mass and microarchitectural changes in bone tissue that increase the susceptibility to fracture. Secondary osteoporosis is loosely defined as low bone mineral density or increased risk of fragility fracture caused by any factor other than aging or postmenopausal status. The purpose of this review is to discuss the current understanding of the pathophysiology and contribution to fracture risk of many of the more common causes of secondary osteoporosis, as well as diagnostic considerations, outlined by organ system. While not comprehensive, included are a wide array of diseases, conditions, and medications that have been associated with bone loss and susceptibility to fractures. The hope is to highlight the importance to the general clinician of screening for and treating the osteoporosis in these patients, so to limit the resultant increased morbidity associated with fractures.
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Affiliation(s)
- Gregory R Emkey
- Pennsylvania Regional Center for Arthritis & Osteoporosis Research, 1200 Broadcasting Road, Suite 200, Wyomissing, PA 19610, USA.
| | - Sol Epstein
- Mt Sinai School of Medicine, I Gustave Levy Place New York, New York, NY, USA
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Recurrent Falls in People with Parkinson's Disease without Cognitive Impairment: Focusing on Modifiable Risk Factors. PARKINSONS DISEASE 2014; 2014:432924. [PMID: 25506466 PMCID: PMC4259076 DOI: 10.1155/2014/432924] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 10/21/2014] [Accepted: 11/04/2014] [Indexed: 01/24/2023]
Abstract
Falls can be considered a disabling feature in Parkinson's disease. We aimed to identify risk factors for falling, testing simultaneously the ability of disease-specific and balance-related measures. We evaluated 171 patients, collecting demographic and clinical data, including standardized assessments with the Unified Parkinson's Disease Rating Scale (UPDRS), activities of daily living (ADL) and motor sections, modified Hoehn and Yahr Scale, Schwab and England, eight-item Parkinson's Disease Questionnaire, Activities-specific Balance Confidence Scale, Falls Efficacy Scale-International (FES-I), Berg Balance Scale, Dynamic Gait Index, Functional Reach, and Timed Up and Go. ROC curves were constructed to determine the cutoff scores for all measures. Variables with P < 0.1 entered a logistic regression model. The prevalence of recurrent falls was 30% (95% CI 24%–38%). In multivariate analysis, independent risk factors for recurrent falls were (P < 0.05) levodopa equivalent dose (OR = 1.283 per 100 mg increase; 95% CI = 1.092–1.507), UPDRS-ADL > 16 points (OR = 10.0; 95% CI = 3.6–28.3), FES-I > 30 points (OR = 6.0; 95% CI = 1.6–22.6), and Berg ≤ 48 points (OR = 3.9; 95% CI = 1.2–12.7).We encourage the utilization of these modifiable risk factors in the screening of fall risk.
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244
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Morgan P, Murphy A, Opheim A, Pogrebnoy D, Kravtsov S, McGinley J. The safety and feasibility of an intervention to improve balance dysfunction in ambulant adults with cerebral palsy: a pilot randomized controlled trial. Clin Rehabil 2014; 29:907-19. [PMID: 25413169 DOI: 10.1177/0269215514556299] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/29/2014] [Indexed: 11/15/2022]
Abstract
Objective: To investigate the safety, feasibility and potential efficacy of balance training in adults with cerebral palsy. Design: Phase 2, assessor-blinded randomized controlled trial. Setting: Outpatient rehabilitation facility. Subjects: A total of 17 ambulatory adults with cerebral palsy. Interventions: Participants were randomly allocated to an eight-week, once-weekly, small group programme of balance training, or seated attention control activity. Balance training was individually tailored using the Balance Evaluation Systems test. Main measures: Primary focus was feasibility, addressed by recruitment, retention, adherence, and safety. Efficacy was primarily evaluated with the Ambulatory Self-Confidence Questionnaire and the Balance Evaluation Systems test, at intervention conclusion and Week 24. Secondary outcomes included gait speed, walking distance, falls efficacy, fatigue, quality of life, and global impression of change. Results: Interventions were safe and feasible with no major adverse events. Adherence was high. At eight and 24 weeks, there were negligible between-group differences in Balance Evaluation systems test total. At 24 weeks, there was a small, non-significant between-group difference in favour of the balance group with effect sizes of 0.14 for ambulatory self-confidence, 0.10 for falls efficacy, and 0.12 for fatigue. There were significant between-group differences for self-reported walking confidence and balance change, in favour of the balance group at Weeks 8 and 24 ( p < 0.05). Conclusion: A customised balance programme is feasible and safe for ambulant adults with cerebral palsy. Small effects from balance training in selected outcomes occurred. Study replication with at least 38 participants per group to confirm efficacy is warranted.
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Affiliation(s)
- Prue Morgan
- Department of Physiotherapy, Monash University, Victoria, Australia
| | - Anna Murphy
- Clinical Research Centre for Movement Disorders & Gait, Monash Health, Victoria, Australia
| | - Arve Opheim
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Dina Pogrebnoy
- Department of Physiotherapy, Monash University, Victoria, Australia
- Clinical Research Centre for Movement Disorders & Gait, Monash Health, Victoria, Australia
| | - Stella Kravtsov
- Clinical Research Centre for Movement Disorders & Gait, Monash Health, Victoria, Australia
| | - Jennifer McGinley
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
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Fukunaga JY, Quitschal RM, Doná F, Ferraz HB, Ganança MM, Caovilla HH. Postural control in Parkinson's disease. Braz J Otorhinolaryngol 2014; 80:508-14. [PMID: 25457071 PMCID: PMC9442668 DOI: 10.1016/j.bjorl.2014.05.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 12/06/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction Postural instability is one of the most disabling features of Parkinson's disease. Objective To evaluate postural balance in Parkinson's disease. Methods Thirty patients with Parkinson's disease were compared with controls using Tetrax™ interactive balance system posturography. Results For different positions, patients with Parkinson's disease showed a significantly higher weight distribution index, fall index, Fourier transformation at low-medium frequencies (F2–F4), and significantly lower right/left and toe/heel synchronization versus controls. Conclusion Postural imbalance in Parkinson's disease patients is characterized by the abnormalities of weight distribution index, synchronization index, Fourier transformation index, and fall index as measured by Tetrax™ posturography.
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Torsney KM, Noyce AJ, Doherty KM, Bestwick JP, Dobson R, Lees AJ. Bone health in Parkinson's disease: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2014; 85:1159-66. [PMID: 24620034 PMCID: PMC4173751 DOI: 10.1136/jnnp-2013-307307] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 01/14/2014] [Accepted: 01/28/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Parkinson's disease (PD) and osteoporosis are chronic diseases associated with increasing age. Single studies have reported associations between them and the major consequence, namely, increased risk of fractures. The aim of this systematic review and meta-analysis was to evaluate the relationship of PD with osteoporosis, bone mineral density (BMD) and fracture risk. METHODS A literature search was undertaken on 4 September 2012 using multiple indexing databases and relevant search terms. Articles were screened for suitability and data extracted where studies met inclusion criteria and were of sufficient quality. Data were combined using standard meta-analysis methods. RESULTS 23 studies were used in the final analysis. PD patients were at higher risk of osteoporosis (OR 2.61; 95% CI 1.69 to 4.03) compared with healthy controls. Male patients had a lower risk for osteoporosis and osteopenia than female patients (OR 0.45; 95% CI 0.29 to 0.68). PD patients had lower hip, lumbar spine and femoral neck BMD levels compared with healthy controls; mean difference, -0.08, 95% CI -0.13 to -0.02 for femoral neck; -0.09, 95% CI -0.15 to -0.03 for lumbar spine; and -0.05, 95% CI -0.07 to -0.03 for total hip. PD patients were also at increased risk of fractures (OR 2.28; 95% CI 1.83 to 2.83). CONCLUSIONS This systematic review and meta-analysis demonstrate that PD patients are at higher risk for both osteoporosis and osteopenia compared with healthy controls, and that female patients are at greater risk than male patients. Patients with PD also have lower BMD and are at increased risk of fractures.
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Affiliation(s)
| | - Alastair J Noyce
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK
| | - Karen M Doherty
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK
| | - Jonathan P Bestwick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Ruth Dobson
- Blizard Institute, Centre for Neuroscience and Trauma, Queen Mary University of London, London, UK
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK
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Duncan RP, Earhart GM. Are the effects of community-based dance on Parkinson disease severity, balance, and functional mobility reduced with time? A 2-year prospective pilot study. J Altern Complement Med 2014; 20:757-63. [PMID: 25192393 DOI: 10.1089/acm.2012.0774] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine the effects of participation in a 2-year community-based dance class on disease severity and functional mobility in people with Parkinson disease (PD). DESIGN Randomized controlled trial. SETTINGS/LOCATION Dance classes took place in a community-based location. Outcome measures were collected in a university laboratory. PATIENTS Ten individuals with PD were randomly assigned to the Argentine tango (AT) group (n=5 [4 men]; mean age±standard deviation, 69.6±6.6 years) or the control group (n=5 [4 men]; mean age±standard deviation, 66±11.0 years). INTERVENTIONS The AT group participated in a community-based AT class for 1 hour twice weekly for 2 years. Control group participants were given no prescribed exercise. Blinded assessments occurred at baseline and 12 and 24 months. OUTCOME MEASURES Movement Disorder Society-Unified Parkinson Disease Rating Scale (MDS-UPDRS) III, Mini-Balance Evaluation Systems Test (Mini-BESTest), gait velocity (forward and backward), Timed Up and Go and dual-task Timed Up and Go, Six-Minute Walk Test (6MWT), MDS-UPDRS II, MDS-UPDRS I, and Freezing of Gait Questionnaire. RESULTS There were no differences between groups at baseline. A significant group-by-time interaction (F [2,8]=17.59; p<0.0001) was noted for the MDS-UPDRS III, with the AT group having lower scores at 12 and 24 months than the controls. Significant interactions were also noted for the Mini-BESTest, MDS-UPDRS II and I, and 6MWT. CONCLUSION This is believed to be one of the longest-duration studies to examine the effects of exercise on PD. Participation in community-based dance classes over 2 years was associated with improvements in motor and nonmotor symptom severity, performance on activities of daily living, and balance in a small group of people with PD. This is noteworthy given the progressive nature of PD and the fact that the control group declined on some outcome measures over 2 years.
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Affiliation(s)
- Ryan P Duncan
- 1 Program in Physical Therapy, Washington University School of Medicine in St. Louis , St. Louis, MO
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Impaired executive function can predict recurrent falls in Parkinson's disease. Arch Phys Med Rehabil 2014; 95:2390-5. [PMID: 25175162 DOI: 10.1016/j.apmr.2014.08.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 05/21/2014] [Accepted: 08/01/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To examine whether impairment in executive function independently predicts recurrent falls in people with Parkinson's disease (PD). DESIGN Prospective cohort study. SETTING University motor control research laboratory. PARTICIPANTS A convenience sample of community-dwelling people with PD (N=144) was recruited from a patient self-help group and movement disorders clinics. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Executive function was assessed with the Mattis Dementia Rating Scale Initiation/Perseveration (MDRS-IP) subtest, and fear of falling (FoF) with the Activities-specific Balance Confidence (ABC) Scale. All participants were followed up for 12 months to record the number of monthly fall events. RESULTS Forty-two people with PD had at least 2 falls during the follow-up period and were classified as recurrent fallers. After accounting for demographic variables and fall history (P=.001), multiple logistic regression analysis showed that the ABC scores (P=.014) and MDRS-IP scores (P=.006) were significantly associated with future recurrent falls among people with PD. The overall accuracy of the prediction was 85.9%. With the use of the significant predictors identified in multiple logistic regression analysis, a prediction model determined by the logistic function was generated: Z = 1.544 + .378 (fall history) - .045 (ABC) - .145 (MDRS-IP). CONCLUSIONS Impaired executive function is a significant predictor of future recurrent falls in people with PD. Participants with executive dysfunction and greater FoF at baseline had a significantly greater risk of sustaining a recurrent fall within the subsequent 12 months.
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Quantification of postural stability in older adults using mobile technology. Exp Brain Res 2014; 232:3861-72. [DOI: 10.1007/s00221-014-4069-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 08/05/2014] [Indexed: 10/24/2022]
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Bonnet CT, Delval A, Defebvre L. Interest of active posturography to detect age-related and early Parkinson's disease-related impairments in mediolateral postural control. J Neurophysiol 2014; 112:2638-46. [PMID: 25143549 DOI: 10.1152/jn.00412.2014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Patients with Parkinson's disease display impairments of postural control most particularly in active, challenging conditions. The objective of the present study was to analyze early signs of disease-related and also age-related impairments in mediolateral body extension and postural control. Fifty-five participants (18 Hoehn and Yahr stage 2 patients in the off-drug condition, 18 healthy elderly control subjects, and 19 young adults) were included in the study. The participants performed a quiet stance task and two active tasks that analyzed the performance in mediolateral body motion: a limit of stability and a rhythmic weight shift task. As expected, the patients displayed significantly lower and slower body displacement (head, neck, lower back, center of pressure) than elderly control subjects when performing the two body excursion tasks. However, the behavioral variability in both tasks was similar between the groups. Under these active conditions, the patients showed significantly lower contribution of the hip postural control mechanisms compared with the elderly control subjects. Overall, the patients seemed to lower their performance in order to prevent a mediolateral postural instability. However, these patients, at an early stage of their disease, were not unstable in quiet stance. Complementarily, elderly control subjects displayed slower body performance than young adults, which therefore showed an additional age-related impairment in mediolateral postural control. Overall, the study illustrated markers of age-related and Parkinson's disease impairments in mediolateral postural control that may constrain everyday activities in elderly adults and even more in patients with Parkinson's disease.
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Affiliation(s)
- Cédrick T Bonnet
- Laboratoire de Neurosciences Fonctionnelles et Pathologies, CNRS, Université Lille, Lille, France;
| | - Arnaud Delval
- EA 1046, Service de Neurophysiologie Clinique, Hôpital Salengro, CHRU, Lille, France; and
| | - Luc Defebvre
- EA 1046, Service de Neurophysiologie Clinique, Hôpital Salengro, CHRU, Lille, France; and Service de Neurologie et Pathologie du Mouvement, Hôpital Salengro, CHRU, Lille, France
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