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Fall Frequency, Risk Factors, and Outcomes in Parkinson's Disease: A Cross-Sectional Analysis.

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Falls are common in Parkinson's disease (PD), increasing with disease progression. This study highlights fall frequency as a potential marker for PD progression and guides prevention strategies.

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NSD-ISSParkinsonfallrisk factors

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Area of Science:

  • Neurology
  • Gerontology
  • Movement Disorders

Background:

  • Falls represent a significant cause of morbidity in Parkinson's disease (PD).
  • The progression of fall risk and outcomes throughout PD remains incompletely understood.

Purpose of the Study:

  • To compare fall risk and outcomes in PD, prodromal alpha-synucleinopathy (PAS), and healthy controls (HC).
  • To estimate fall frequency across different stages of PD progression.
  • To characterize the clinical features of PD patient subgroups who experience frequent falls.

Main Methods:

  • Analysis of fall-related outcomes from the Parkinson's Progression Markers Initiative (PPMI) database.
  • Estimation of yearly fall rates based on time since PD diagnosis.
  • Categorization of PD participants into never, rare, or frequent faller groups.
  • Assessment of clinical variables including motor, cognitive, behavioral, sleep, and autonomic functions.
  • Statistical analysis using regression models adjusted for relevant covariates and corrected for multiple comparisons.

Main Results:

  • PD participants exhibited significantly higher odds of falling compared to PAS and HC.
  • PD patients were more likely to experience fall-related injuries and require healthcare utilization than PAS and HC.
  • Fall incidence increased from 15.5% at diagnosis to 69.2% by 14 years post-diagnosis, correlating with advancing Neuronal Synuclein Disease-Integrated Staging System (NSD-ISS) stages.
  • Frequent fallers demonstrated longer disease duration, higher NSD-ISS, and poorer overall clinical profiles.
  • Women experienced falls more frequently than men, despite presenting with milder PD symptoms.

Conclusions:

  • Fall frequency and associated morbidity escalate with PD duration and NSD-ISS stage.
  • Fall risk is influenced by a multifactorial interplay of sex, motor, and non-motor symptoms.
  • Tracking fall frequency may serve as a practical indicator of PD progression and inform targeted fall prevention strategies.