Neurology Today – Falls Occur Often and Early in Parkinson’s Disease

Neurology Today – Falls Occur Often and Early in Parkinson’s Disease


BERLIN—More than 40 percent of patients with early Parkinson’s disease reported falling, and a history of falls was a predictor of future falls, according to the results of a study reported here June 22 at the International Congress of Parkinson’s Disease and Movement Disorders.

“Falling is a very serious problem in Parkinson’s disease,” said Kelvin Chou, MD, the Thomas and Susan C. Brown Early Career professor of neurology at the University of Michigan in Ann Arbor. “With this study, we wondered if we could identify people who fall early on in their disease and try to understand the risk factors.”

Dr. Chou and his colleagues at more than 12 Parkinson’s disease centers around the country culled data from the NIH Exploratory Trials in Parkinson’s Disease LS-1 (NET-PD LS-1) study to determine how common falls are and who was most at risk. The study, which was initially designed to test the neuroprotective effects of creatine, was halted in 2013 after an interim analysis determined that the supplement did not slow disease progression.

The scientists reviewed clinical information from the study to assess how many of the 1,741 patients with early Parkinson’s disease reported a history of falling at baseline and then again during follow-up assessments made three to six years later.

Study subjects had to have been treated with dopaminergic agents for at least three months and no more than two years. At baseline, 132 people reported a fall. Three to six years later, 691 people (40 percent) said they had had a fall since their baseline assessment. Ninety-five of the 132 people (72 percent) who reported a fall at the start of the study subsequently had another fall.

Among the risk factors associated with falling were use of selective serotonin reuptake inhibitors and a patient’s ambulatory capacity score as measured by the Unified Parkinson’s Disease Rating Scale. In smaller numbers, the researchers also found that people who scored worse on the Total Functional Capacity Scale, a test measuring general functional abilities, also had an increased risk of falls.

Men had a lower risk of falls, but there was an interaction of age by sex — men were less likely to fall compared to women until age 80, after which they were more likely to fall, said Dr. Chou. The odds of remaining fall-free were lowest in men and those with a baseline lower ambulatory capacity score.

“This study tells us that we really need to do more work to understand the risk factors for falls,” Dr. Chou told the Neurology Today Conference Reporter. “It’s hard because we don’t know the exact mechanism of falls in this population.”

Commenting on the study, Michael S. Okun, MD, FAAN, the Adelaide Lackner professor and chairman of neurology at University of Florida in Gainesville, said: “This research is important because the NET-PD cohort consisted of people with very early Parkinson’s disease.  Clinicians need to be aware that just because patients are newly diagnosed does not mean that they will not fall.”

“Many practitioners are under the false impression that there is nothing that can be done to prevent falling,” said Dr. Okun, who is co-director of the university’s Movement Disorders Center. “Early identification of risk factors, medication optimization, and use of an interdisciplinary team, including physical and occupational therapists, can potentially reduce fall risk.”