Clinical and physiological assessments for elucidating falls risk in Parkinson's disease

The study aims were to devise (1) a fall risk screen for people with PD using routine clinical measures and (2) an explanatory (physiological) fall risk assessment for guiding fall prevention interventions. One hundred thirteen people with PD (age 66 ± 95% CI 1.6 years) underwent clinical assessment...

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Veröffentlicht in:	Movement disorders Jg. 24; H. 9; S. 1280 - 1289
Hauptverfasser:	Latt, Mark D., Lord, Stephen R., Morris, John G.L., Fung, Victor S.C.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	Hoboken Wiley Subscription Services, Inc., A Wiley Company 15.07.2009 Wiley
Schlagworte:	accidental falls Accidental Falls - prevention & control Aged Analysis of Variance balance Biological and medical sciences Blood Pressure - physiology Chi-Square Distribution cognitive impairment Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases Female Follow-Up Studies freezing of gait Humans Male Medical sciences Middle Aged muscle strength Neurologic Examination Neurology Neuropsychological Tests Parkinson Disease - physiopathology Parkinson Disease - therapy Parkinson's disease Predictive Value of Tests Reaction Time - physiology Risk Assessment - methods Risk Factors Sex Factors Nervous system diseases Cognitive disorder Parkinson's disease Parkinson disease freezing of gait Freezing Cerebral disorder muscle strength balance Central nervous system disease Risk factor accidental falls Degenerative disease cognitive impairment Strength Extrapyramidal syndrome
ISSN:	0885-3185, 1531-8257, 1531-8257
Online-Zugang:	Volltext
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Abstract	The study aims were to devise (1) a fall risk screen for people with PD using routine clinical measures and (2) an explanatory (physiological) fall risk assessment for guiding fall prevention interventions. One hundred thirteen people with PD (age 66 ± 95% CI 1.6 years) underwent clinical assessments and quantitative tests of sway, gait, strength, reaction time, and lower limb sensation. Participants were then followed up for 12 months to determine fall incidence. In the follow‐up year, 51 participants (45%) fell one or more times whereas 62 participants (55%) did not fall. Multivariate analyses of routine clinical measures revealed that a fall in the past year, abnormal axial posture, cognitive impairment, and freezing of gait were independent risk factors for falls and predicted 38/51 fallers (75%) and 45/62 non‐fallers (73%). A multivariate model combining clinical and physiological measures that elucidate the pathophysiology of falls identified abnormal posture, freezing of gait, frontal impairment, poor leaning balance, and leg weakness as independent risk factors. This model correctly classified 39/51 fallers (77%) and 51/62 non‐fallers (82%). Patients with PD at risk of falls can be identified accurately with routine clinical assessments and quantitative physiological tests. Many of the risk factors identified are amenable to targeted intervention. © 2009 Movement Disorder Society
AbstractList	The study aims were to devise (1) a fall risk screen for people with PD using routine clinical measures and (2) an explanatory (physiological) fall risk assessment for guiding fall prevention interventions. One hundred thirteen people with PD (age 66 ± 95% CI 1.6 years) underwent clinical assessments and quantitative tests of sway, gait, strength, reaction time, and lower limb sensation. Participants were then followed up for 12 months to determine fall incidence. In the follow-up year, 51 participants (45%) fell one or more times whereas 62 participants (55%) did not fall. Multivariate analyses of routine clinical measures revealed that a fall in the past year, abnormal axial posture, cognitive impairment, and freezing of gait were independent risk factors for falls and predicted 38/51 fallers (75%) and 45/62 non-fallers (73%). A multivariate model combining clinical and physiological measures that elucidate the pathophysiology of falls identified abnormal posture, freezing of gait, frontal impairment, poor leaning balance, and leg weakness as independent risk factors. This model correctly classified 39/51 fallers (77%) and 51/62 non-fallers (82%). Patients with PD at risk of falls can be identified accurately with routine clinical assessments and quantitative physiological tests. Many of the risk factors identified are amenable to targeted intervention. The study aims were to devise (1) a fall risk screen for people with PD using routine clinical measures and (2) an explanatory (physiological) fall risk assessment for guiding fall prevention interventions. One hundred thirteen people with PD (age 66 +/- 95% CI 1.6 years) underwent clinical assessments and quantitative tests of sway, gait, strength, reaction time, and lower limb sensation. Participants were then followed up for 12 months to determine fall incidence. In the follow-up year, 51 participants (45%) fell one or more times whereas 62 participants (55%) did not fall. Multivariate analyses of routine clinical measures revealed that a fall in the past year, abnormal axial posture, cognitive impairment, and freezing of gait were independent risk factors for falls and predicted 38/51 fallers (75%) and 45/62 non-fallers (73%). A multivariate model combining clinical and physiological measures that elucidate the pathophysiology of falls identified abnormal posture, freezing of gait, frontal impairment, poor leaning balance, and leg weakness as independent risk factors. This model correctly classified 39/51 fallers (77%) and 51/62 non-fallers (82%). Patients with PD at risk of falls can be identified accurately with routine clinical assessments and quantitative physiological tests. Many of the risk factors identified are amenable to targeted intervention.The study aims were to devise (1) a fall risk screen for people with PD using routine clinical measures and (2) an explanatory (physiological) fall risk assessment for guiding fall prevention interventions. One hundred thirteen people with PD (age 66 +/- 95% CI 1.6 years) underwent clinical assessments and quantitative tests of sway, gait, strength, reaction time, and lower limb sensation. Participants were then followed up for 12 months to determine fall incidence. In the follow-up year, 51 participants (45%) fell one or more times whereas 62 participants (55%) did not fall. Multivariate analyses of routine clinical measures revealed that a fall in the past year, abnormal axial posture, cognitive impairment, and freezing of gait were independent risk factors for falls and predicted 38/51 fallers (75%) and 45/62 non-fallers (73%). A multivariate model combining clinical and physiological measures that elucidate the pathophysiology of falls identified abnormal posture, freezing of gait, frontal impairment, poor leaning balance, and leg weakness as independent risk factors. This model correctly classified 39/51 fallers (77%) and 51/62 non-fallers (82%). Patients with PD at risk of falls can be identified accurately with routine clinical assessments and quantitative physiological tests. Many of the risk factors identified are amenable to targeted intervention. The study aims were to devise (1) a fall risk screen for people with PD using routine clinical measures and (2) an explanatory (physiological) fall risk assessment for guiding fall prevention interventions. One hundred thirteen people with PD (age 66 ± 95% CI 1.6 years) underwent clinical assessments and quantitative tests of sway, gait, strength, reaction time, and lower limb sensation. Participants were then followed up for 12 months to determine fall incidence. In the follow‐up year, 51 participants (45%) fell one or more times whereas 62 participants (55%) did not fall. Multivariate analyses of routine clinical measures revealed that a fall in the past year, abnormal axial posture, cognitive impairment, and freezing of gait were independent risk factors for falls and predicted 38/51 fallers (75%) and 45/62 non‐fallers (73%). A multivariate model combining clinical and physiological measures that elucidate the pathophysiology of falls identified abnormal posture, freezing of gait, frontal impairment, poor leaning balance, and leg weakness as independent risk factors. This model correctly classified 39/51 fallers (77%) and 51/62 non‐fallers (82%). Patients with PD at risk of falls can be identified accurately with routine clinical assessments and quantitative physiological tests. Many of the risk factors identified are amenable to targeted intervention. © 2009 Movement Disorder Society The study aims were to devise (1) a fall risk screen for people with PD using routine clinical measures and (2) an explanatory (physiological) fall risk assessment for guiding fall prevention interventions. One hundred thirteen people with PD (age 66 +/- 95% CI 1.6 years) underwent clinical assessments and quantitative tests of sway, gait, strength, reaction time, and lower limb sensation. Participants were then followed up for 12 months to determine fall incidence. In the follow-up year, 51 participants (45%) fell one or more times whereas 62 participants (55%) did not fall. Multivariate analyses of routine clinical measures revealed that a fall in the past year, abnormal axial posture, cognitive impairment, and freezing of gait were independent risk factors for falls and predicted 38/51 fallers (75%) and 45/62 non-fallers (73%). A multivariate model combining clinical and physiological measures that elucidate the pathophysiology of falls identified abnormal posture, freezing of gait, frontal impairment, poor leaning balance, and leg weakness as independent risk factors. This model correctly classified 39/51 fallers (77%) and 51/62 non-fallers (82%). Patients with PD at risk of falls can be identified accurately with routine clinical assessments and quantitative physiological tests. Many of the risk factors identified are amenable to targeted intervention.
Author	Latt, Mark D. Fung, Victor S.C. Morris, John G.L. Lord, Stephen R.
Author_xml	– sequence: 1 givenname: Mark D. surname: Latt fullname: Latt, Mark D. organization: Department of Aged Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia – sequence: 2 givenname: Stephen R. surname: Lord fullname: Lord, Stephen R. email: s.lord@powmri.edu.au organization: Prince of Wales Medical Research Institute, UNSW, Randwick, New South Wales, Australia – sequence: 3 givenname: John G.L. surname: Morris fullname: Morris, John G.L. organization: Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia – sequence: 4 givenname: Victor S.C. surname: Fung fullname: Fung, Victor S.C. organization: Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia
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ContentType	Journal Article
Copyright	Copyright © 2009 Movement Disorder Society 2009 INIST-CNRS 2009 Movement Disorder Society.
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ISSN	0885-3185 1531-8257
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IsPeerReviewed	true
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Issue	9
Keywords	Nervous system diseases Cognitive disorder Parkinson's disease Parkinson disease freezing of gait Freezing Cerebral disorder muscle strength balance Central nervous system disease Risk factor accidental falls Degenerative disease cognitive impairment Strength Extrapyramidal syndrome
Language	English
License	http://onlinelibrary.wiley.com/termsAndConditions#vor CC BY 4.0 2009 Movement Disorder Society.
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Notes	istex:C7F838555BD8188320EB81FF0D0EF33CF0CF177C Potential conflict of interest: Mark Latt was funded by a University of Sydney PhD Scholarship to undertake this study and Stephen Lord is supported by a NHMRC Senior Principal Research Fellowship. Stephen Lord is a company director of Balance Systems Inc, which makes equipment items for the PPA (POWMRI FallScreen) which is commercially available through the Prince of Wales Medical Research Institute. ArticleID:MDS22561 ark:/67375/WNG-6G5ML091-8 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
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PublicationCentury	2000
PublicationDate	15 July 2009
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PublicationPlace	Hoboken
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PublicationTitle	Movement disorders
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PublicationYear	2009
Publisher	Wiley Subscription Services, Inc., A Wiley Company Wiley
Publisher_xml	– name: Wiley Subscription Services, Inc., A Wiley Company – name: Wiley
References	Falvo MJ,Schilling BK,Earhart GM. Parkinson's disease and resistive exercise: rationale, review, and recommendations. Mov Disord 2008; 23: 1-11. Marchese R,Bove M,Abbruzzese G. Effect of cognitive and motor tasks on postural stability in Parkinson's disease: a posturographic study. Mov Disord 2003; 18: 652-658. Hely MA,Reid WGJ,Adena MA,Halliday GM,Morris JGL. The Sydney multicenter study of Parkinson's disease: the inevitability of dementia at 20 years. Mov Disord 2008; 23: 837-844. Koller WC,Glatt S,Vetere-Overfield B,Hassanein R. Falls and Parkinson's disease. Clin Neuropharmacol 1989; 12: 98-105. Lange KW,Robbins TW,Marsden CD,James M,Owen AM,Paul GM. L-dopa withdrawal in Parkinson's disease selectively impairs cognitive performance in tests sensitive to frontal lobe dysfunction. Psychopharmacol 1992; 107: 394-404. Williams DR,Watt HC,Lees AJ. Predictors of falls and fractures in bradykinetic rigid syndromes: a retrospective study. J Neurol Neurosurg Psychiatry 2006; 77: 468-473. Gray P,Hildebrand K. Fall risk factors in Parkinson's disease. J Neurosci Nurs 2000; 32: 222-228. Giladi N. Gait disturbances in advanced stages of Parkinson's disease. Adv Neurol 2001; 86: 273-278. Landers MR,Backlund A,Davenport J,Fortune J,Schuerman S,Altenburger P. Postural instability in idiopathic Parkinson's disease: discriminating fallers from nonfallers based on standardized clinical measures. J Neurol Phys Ther 2008; 32: 56-61. Matinolli M,Korpelainen JT,Korpelainen R,Sotaniemi KA,Virranniemi M,Myllyla VV. Postural sway and falls in Parkinson's disease: a regression approach. Mov Disord 2007; 22: 1927-1935. Bloem BR,Hausdorff JM,Visser JE,Giladi N. Falls and freezing of gait in Parkinson's disease: a review of two interconnected, episodic phenomena. Mov Disord 2004; 19: 871-884. Giladi N,Shabtai H,Simon ES,Biran S,Tal J,Korczyn AD. Construction of freezing of gait questionnaire for patients with Parkinsonism. Parkinsonism Rel Disord 2000; 6: 165-170. Robinson K,Dennison A,Roalf D, et al. Falling risk factors in Parkinson's disease. Neurorehabil 2005; 20: 169-182. Gehlsen GM,Whaley MH. Falls in the elderly: Part II, Balance, strength, and flexibility. Arch Phys Med Rehabil 1990; 71: 739-741. Owen AM,James M,Leigh PN, et al. Fronto-striatal cognitive deficits at different stages of Parkinson's disease. Brain 1992; 115: 1727-1751. Dibble LE,Hale TF,Marcus RL,Droge J,Gerber JP,LaStayo PC. High-intensity resistance training amplifies muscle hypertrophy and functional gains in persons with Parkinson's disease. Mov Disord 2006; 21: 1444-1452. Lord SR,Ward JA,Williams P. Exercise effect on dynamic stability in older women: a randomized controlled trial. Arch Phys Med Rehabil 1996; 77: 232-236. Lord SR,Clark RD,Webster IW. Postural stability and associated physiological factors in a population of aged persons. J Gerontol A 1991; 46: M69-M76. Bloem BR,Grimbergen YA,Cramer M,Willemsen M,Zwinderman AH. Prospective assessment of falls in Parkinson's disease. J Neurol 2001; 248: 950-958. Gibson. The prevention of falls in later life. A report of the Kellogg International Work Group on the Prevention of Falls by the Elderly. Dan Med Bull 1987; 34( Suppl 4): 1-24. Ashburn A,Fazakarley L,Ballinger C,Pickering R,McLellan LD,Fitton C. A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson's disease. J Neurol Neurosurg Psychiatry 2007; 78: 678-684. Ashburn A,Stack E,Pickering RM,Ward CD. Predicting fallers in a community-based sample of people with Parkinson's disease. Gerontology 2001; 47: 277-281. Koller W,Kase S. Muscle strength testing in Parkinson's disease. Eur Neurol 1986; 25: 130-133. Bloem BR. Postural instability in Parkinson's disease. Clin Neurol Neurosurg 1992; 94 ( Suppl): S41-S45. Wood BH,Bilclough JA,Bowron A,Walker RW. Incidence and prediction of falls in Parkinson's disease: a prospective multidisciplinary study. J Neurol Neurosurg Psychiatry 2002; 72: 721-725. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. J Neurolog Sci 1996; 144: 218-219. Bloem BR,Van Dijk JG,Beckley DJ,Roos RA,Remler MP,Bruyn GW. Altered postural reflexes in Parkinson's disease: a reverse hypothesis. Med Hypotheses 1992; 39: 243-247. Nieuwboer A,Kwakkel G,Rochester L, et al. Cueing training in the home improves gait-related mobility in Parkinson's disease: the RESCUE trial. J Neurol Neurosurg Psychiatr 2007; 78: 134-140. Balash Y,Peretz C,Leibovich G,Herman T,Hausdorff JM,Giladi N. Falls in outpatients with Parkinson's disease: frequency, impact and identifying factors. J Neurol 2005; 252: 1310-1315. Nallegowda M,Singh U,Handa G, et al. Role of sensory input and muscle strength in maintenance of balance, gait, and posture in Parkinson's disease: a pilot study. Am J Phys Med Rehabil 2004; 83: 898-908. Giladi N,McDermott MP,Fahn S, et al. Freezing of gait in PD: prospective assessment in the DATATOP cohort. Neurology 2001; 56: 1712-1721. Valkovic P,Brozova H,Botzel K,Ruzicka E,Benetin J. Push-and-release test predicts Parkinson fallers and nonfallers better than the pull test: comparison in OFF and ON medication states. Mov Disord 2008; 23: 1453-1457. Carter ND,Khan KM,Mallinson A,Janssen PA. Knee strength is a significant determinant of static and dynamic balance as well as quality of life in older community-dwelling women with osteoporosis. Gerontology 2002; 48: 360-368. Pickering RM,Grimbergen YAM,Rigney U, et al. A meta-analysis of six prospective studies of falling in Parkinson's disease. Mov Disord 2007; 22: 1892-1900. Schrag A,Ben-Shlomo Y,Quinn N. How common are complications of Parkinson's disease? J Neurol 2002; 249: 419-423. Ashburn A,Stack E,Pickering RM,Ward CD. A community-dwelling sample of people with Parkinson's disease: characteristics of fallers and non-fallers. Age Ageing 2001; 30: 47-52. Gotham AM,Brown RG,Marsden CD. 'Frontal' cognitive function in patients with Parkinson's disease 'on' and 'off' levodopa. Brain 1988; 111: 299-321. Lord SR,Menz HB,Tiedemann A. A physiological profile approach to falls risk assessment and prevention. Phys Ther 2003; 83: 237-252. Inkster LM,Eng JJ,MacIntyre DL,Stoessl AJ. Leg muscle strength is reduced in Parkinson's disease and relates to the ability to rise from a chair. Mov Disord 2003; 18: 157-162. Dubois B,Slachevsky A,Litvan I,Pillon B. The FAB: a Frontal Assessment Battery at bedside. Neurology 2000; 55: 1621-1626. Sherrington C,Whitney JC,Lord SR,Herbert RD,Cumming RG,Close JCT. Effective approaches to exercise in the prevention of falls - a systematic review and meta-analysis. J Am Geriatr Soc 2008; 56: 2234-2243. Morris JC,Rubin EH,Morris EJ,Mandel SA. Senile dementia of the Alzheimer's type: an important risk factor for serious falls. J Gerontol 1987; 42: 412-417. Melton LJ,Leibson CL,Achenbach SJ, et al. Fracture risk after the diagnosis of Parkinson's disease: influence of concomitant dementia. Mov Disord 2006; 21: 1361-1367. Hughes AJ,Ben-Shlomo Y,Daniel SE,Lees AJ. What features improve the accuracy of clinical diagnosis in Parkinson's disease: a clinicopathologic study. Neurology 1992; 42: 1142-1146. Whipple RH,Wolfson LI,Amerman PM. The relationship of knee and ankle weakness to falls in nursing home residents: an isokinetic study. J Am Geriatr Soc 1987; 35: 13-20. Folstein M,Folstein S. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-198. Mathias S,Nayak US,Isaacs B. Balance in elderly patients: the "get-up and go" test. Arch Phys Med Rehabil 1986; 67: 387-389. Schieppati M,Hugon M,Grasso M,Nardone A,Galante M. The limits of equilibrium in young and elderly normal subjects and in Parkinsonians. Electroencephalography Clin Neurophysiol 1994; 93: 286-298. Hoehn MM,Yahr MD. Parkinsonism: onset, progression, and mortality. Neurology 1967; 17: 427-442. Lord SR,Clark RD,Webster IW. Postural stability and associated physiological factors in a population of aged persons. J Gerontol Med Sci 1991; 46: M69-M76. Morris M,Iansek R,Smithson F,Huxham F. Postural instability in Parkinson's disease: a comparison with and without a concurrent task. Gait Posture 2000; 12: 205-216. Menz HB,Lord SR,Fitzpatrick RC. Age-related differences in walking stability. Age Ageing 2003; 32: 137-142. 1987; 35 1987; 34 2004; 83 2005; 252 2000; 6 2002; 72 2006; 77 1992; 39 1975; 12 2005; 20 1992; 107 2008; 56 2008; 32 1996; 144 2003; 18 2001; 47 2007; 78 1992; 94 2003; 32 2001; 86 2001; 248 1996; 77 2002; 48 1987; 42 1989; 12 2004; 19 1991; 46 2006; 21 2000; 12 2000; 32 1986; 67 2000; 55 1986; 25 1992; 115 2002; 249 1967; 17 1987 2008; 23 1988; 111 1992; 42 2003; 83 2001; 56 2007; 22 1994; 93 2001; 30 1990; 71 e_1_2_6_51_2 e_1_2_6_53_2 e_1_2_6_30_2 e_1_2_6_19_2 e_1_2_6_13_2 e_1_2_6_34_2 e_1_2_6_11_2 e_1_2_6_32_2 Gehlsen GM (e_1_2_6_29_2) 1990; 71 e_1_2_6_17_2 e_1_2_6_38_2 Gibson (e_1_2_6_42_2) 1987; 34 Giladi N (e_1_2_6_36_2) 2001; 86 Mathias S (e_1_2_6_37_2) 1986; 67 e_1_2_6_20_2 e_1_2_6_41_2 e_1_2_6_7_2 e_1_2_6_9_2 e_1_2_6_3_2 e_1_2_6_5_2 e_1_2_6_24_2 e_1_2_6_47_2 e_1_2_6_22_2 e_1_2_6_49_2 e_1_2_6_28_2 e_1_2_6_43_2 e_1_2_6_26_2 e_1_2_6_45_2 e_1_2_6_50_2 e_1_2_6_52_2 e_1_2_6_31_2 Robinson K (e_1_2_6_15_2) 2005; 20 e_1_2_6_18_2 e_1_2_6_12_2 e_1_2_6_35_2 e_1_2_6_10_2 e_1_2_6_33_2 e_1_2_6_16_2 e_1_2_6_39_2 e_1_2_6_54_2 e_1_2_6_14_2 e_1_2_6_40_2 e_1_2_6_8_2 e_1_2_6_4_2 e_1_2_6_6_2 e_1_2_6_23_2 e_1_2_6_48_2 e_1_2_6_2_2 e_1_2_6_21_2 e_1_2_6_27_2 e_1_2_6_44_2 e_1_2_6_25_2 e_1_2_6_46_2
References_xml	– reference: Ashburn A,Fazakarley L,Ballinger C,Pickering R,McLellan LD,Fitton C. A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson's disease. J Neurol Neurosurg Psychiatry 2007; 78: 678-684. – reference: Hughes AJ,Ben-Shlomo Y,Daniel SE,Lees AJ. What features improve the accuracy of clinical diagnosis in Parkinson's disease: a clinicopathologic study. Neurology 1992; 42: 1142-1146. – reference: Morris JC,Rubin EH,Morris EJ,Mandel SA. Senile dementia of the Alzheimer's type: an important risk factor for serious falls. J Gerontol 1987; 42: 412-417. – reference: Nieuwboer A,Kwakkel G,Rochester L, et al. Cueing training in the home improves gait-related mobility in Parkinson's disease: the RESCUE trial. J Neurol Neurosurg Psychiatr 2007; 78: 134-140. – reference: Valkovic P,Brozova H,Botzel K,Ruzicka E,Benetin J. Push-and-release test predicts Parkinson fallers and nonfallers better than the pull test: comparison in OFF and ON medication states. Mov Disord 2008; 23: 1453-1457. – reference: Lord SR,Clark RD,Webster IW. Postural stability and associated physiological factors in a population of aged persons. J Gerontol Med Sci 1991; 46: M69-M76. – reference: Ashburn A,Stack E,Pickering RM,Ward CD. A community-dwelling sample of people with Parkinson's disease: characteristics of fallers and non-fallers. Age Ageing 2001; 30: 47-52. – reference: Williams DR,Watt HC,Lees AJ. Predictors of falls and fractures in bradykinetic rigid syndromes: a retrospective study. J Neurol Neurosurg Psychiatry 2006; 77: 468-473. – reference: Inkster LM,Eng JJ,MacIntyre DL,Stoessl AJ. Leg muscle strength is reduced in Parkinson's disease and relates to the ability to rise from a chair. Mov Disord 2003; 18: 157-162. – reference: Gotham AM,Brown RG,Marsden CD. 'Frontal' cognitive function in patients with Parkinson's disease 'on' and 'off' levodopa. Brain 1988; 111: 299-321. – reference: Lord SR,Menz HB,Tiedemann A. A physiological profile approach to falls risk assessment and prevention. Phys Ther 2003; 83: 237-252. – reference: Dubois B,Slachevsky A,Litvan I,Pillon B. The FAB: a Frontal Assessment Battery at bedside. Neurology 2000; 55: 1621-1626. – reference: Folstein M,Folstein S. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-198. – reference: Landers MR,Backlund A,Davenport J,Fortune J,Schuerman S,Altenburger P. Postural instability in idiopathic Parkinson's disease: discriminating fallers from nonfallers based on standardized clinical measures. J Neurol Phys Ther 2008; 32: 56-61. – reference: Ashburn A,Stack E,Pickering RM,Ward CD. Predicting fallers in a community-based sample of people with Parkinson's disease. Gerontology 2001; 47: 277-281. – reference: Lord SR,Clark RD,Webster IW. Postural stability and associated physiological factors in a population of aged persons. J Gerontol A 1991; 46: M69-M76. – reference: Gehlsen GM,Whaley MH. Falls in the elderly: Part II, Balance, strength, and flexibility. Arch Phys Med Rehabil 1990; 71: 739-741. – reference: Gibson. The prevention of falls in later life. A report of the Kellogg International Work Group on the Prevention of Falls by the Elderly. Dan Med Bull 1987; 34( Suppl 4): 1-24. – reference: Hoehn MM,Yahr MD. Parkinsonism: onset, progression, and mortality. Neurology 1967; 17: 427-442. – reference: Giladi N,Shabtai H,Simon ES,Biran S,Tal J,Korczyn AD. Construction of freezing of gait questionnaire for patients with Parkinsonism. Parkinsonism Rel Disord 2000; 6: 165-170. – reference: Falvo MJ,Schilling BK,Earhart GM. Parkinson's disease and resistive exercise: rationale, review, and recommendations. Mov Disord 2008; 23: 1-11. – reference: Giladi N,McDermott MP,Fahn S, et al. Freezing of gait in PD: prospective assessment in the DATATOP cohort. Neurology 2001; 56: 1712-1721. – reference: Bloem BR,Hausdorff JM,Visser JE,Giladi N. Falls and freezing of gait in Parkinson's disease: a review of two interconnected, episodic phenomena. Mov Disord 2004; 19: 871-884. – reference: Lord SR,Ward JA,Williams P. Exercise effect on dynamic stability in older women: a randomized controlled trial. Arch Phys Med Rehabil 1996; 77: 232-236. – reference: Whipple RH,Wolfson LI,Amerman PM. The relationship of knee and ankle weakness to falls in nursing home residents: an isokinetic study. J Am Geriatr Soc 1987; 35: 13-20. – reference: Bloem BR,Van Dijk JG,Beckley DJ,Roos RA,Remler MP,Bruyn GW. Altered postural reflexes in Parkinson's disease: a reverse hypothesis. Med Hypotheses 1992; 39: 243-247. – reference: Giladi N. Gait disturbances in advanced stages of Parkinson's disease. Adv Neurol 2001; 86: 273-278. – reference: Carter ND,Khan KM,Mallinson A,Janssen PA. Knee strength is a significant determinant of static and dynamic balance as well as quality of life in older community-dwelling women with osteoporosis. Gerontology 2002; 48: 360-368. – reference: Balash Y,Peretz C,Leibovich G,Herman T,Hausdorff JM,Giladi N. Falls in outpatients with Parkinson's disease: frequency, impact and identifying factors. J Neurol 2005; 252: 1310-1315. – reference: Bloem BR,Grimbergen YA,Cramer M,Willemsen M,Zwinderman AH. Prospective assessment of falls in Parkinson's disease. J Neurol 2001; 248: 950-958. – reference: Robinson K,Dennison A,Roalf D, et al. Falling risk factors in Parkinson's disease. Neurorehabil 2005; 20: 169-182. – reference: Bloem BR. Postural instability in Parkinson's disease. Clin Neurol Neurosurg 1992; 94 ( Suppl): S41-S45. – reference: Lange KW,Robbins TW,Marsden CD,James M,Owen AM,Paul GM. L-dopa withdrawal in Parkinson's disease selectively impairs cognitive performance in tests sensitive to frontal lobe dysfunction. Psychopharmacol 1992; 107: 394-404. – reference: Wood BH,Bilclough JA,Bowron A,Walker RW. Incidence and prediction of falls in Parkinson's disease: a prospective multidisciplinary study. J Neurol Neurosurg Psychiatry 2002; 72: 721-725. – reference: Morris M,Iansek R,Smithson F,Huxham F. Postural instability in Parkinson's disease: a comparison with and without a concurrent task. Gait Posture 2000; 12: 205-216. – reference: Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. J Neurolog Sci 1996; 144: 218-219. – reference: Gray P,Hildebrand K. Fall risk factors in Parkinson's disease. J Neurosci Nurs 2000; 32: 222-228. – reference: Melton LJ,Leibson CL,Achenbach SJ, et al. Fracture risk after the diagnosis of Parkinson's disease: influence of concomitant dementia. Mov Disord 2006; 21: 1361-1367. – reference: Koller W,Kase S. Muscle strength testing in Parkinson's disease. Eur Neurol 1986; 25: 130-133. – reference: Owen AM,James M,Leigh PN, et al. Fronto-striatal cognitive deficits at different stages of Parkinson's disease. Brain 1992; 115: 1727-1751. – reference: Sherrington C,Whitney JC,Lord SR,Herbert RD,Cumming RG,Close JCT. Effective approaches to exercise in the prevention of falls - a systematic review and meta-analysis. J Am Geriatr Soc 2008; 56: 2234-2243. – reference: Menz HB,Lord SR,Fitzpatrick RC. Age-related differences in walking stability. Age Ageing 2003; 32: 137-142. – reference: Matinolli M,Korpelainen JT,Korpelainen R,Sotaniemi KA,Virranniemi M,Myllyla VV. Postural sway and falls in Parkinson's disease: a regression approach. Mov Disord 2007; 22: 1927-1935. – reference: Mathias S,Nayak US,Isaacs B. Balance in elderly patients: the "get-up and go" test. Arch Phys Med Rehabil 1986; 67: 387-389. – reference: Dibble LE,Hale TF,Marcus RL,Droge J,Gerber JP,LaStayo PC. High-intensity resistance training amplifies muscle hypertrophy and functional gains in persons with Parkinson's disease. Mov Disord 2006; 21: 1444-1452. – reference: Pickering RM,Grimbergen YAM,Rigney U, et al. A meta-analysis of six prospective studies of falling in Parkinson's disease. Mov Disord 2007; 22: 1892-1900. – reference: Koller WC,Glatt S,Vetere-Overfield B,Hassanein R. Falls and Parkinson's disease. Clin Neuropharmacol 1989; 12: 98-105. – reference: Marchese R,Bove M,Abbruzzese G. Effect of cognitive and motor tasks on postural stability in Parkinson's disease: a posturographic study. Mov Disord 2003; 18: 652-658. – reference: Hely MA,Reid WGJ,Adena MA,Halliday GM,Morris JGL. The Sydney multicenter study of Parkinson's disease: the inevitability of dementia at 20 years. Mov Disord 2008; 23: 837-844. – reference: Schieppati M,Hugon M,Grasso M,Nardone A,Galante M. The limits of equilibrium in young and elderly normal subjects and in Parkinsonians. Electroencephalography Clin Neurophysiol 1994; 93: 286-298. – reference: Schrag A,Ben-Shlomo Y,Quinn N. How common are complications of Parkinson's disease? J Neurol 2002; 249: 419-423. – reference: Nallegowda M,Singh U,Handa G, et al. Role of sensory input and muscle strength in maintenance of balance, gait, and posture in Parkinson's disease: a pilot study. Am J Phys Med Rehabil 2004; 83: 898-908. – volume: 22 start-page: 1892 year: 2007 end-page: 1900 article-title: A meta‐analysis of six prospective studies of falling in Parkinson's disease publication-title: Mov Disord – volume: 34 start-page: 1 issue: Suppl 4 year: 1987 end-page: 24 article-title: The prevention of falls in later life. 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Snippet	The study aims were to devise (1) a fall risk screen for people with PD using routine clinical measures and (2) an explanatory (physiological) fall risk...
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SubjectTerms	accidental falls Accidental Falls - prevention & control Aged Analysis of Variance balance Biological and medical sciences Blood Pressure - physiology Chi-Square Distribution cognitive impairment Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases Female Follow-Up Studies freezing of gait Humans Male Medical sciences Middle Aged muscle strength Neurologic Examination Neurology Neuropsychological Tests Parkinson Disease - physiopathology Parkinson Disease - therapy Parkinson's disease Predictive Value of Tests Reaction Time - physiology Risk Assessment - methods Risk Factors Sex Factors
Title	Clinical and physiological assessments for elucidating falls risk in Parkinson's disease
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