The Relative Contribution of Physical and Cognitive Fall Risk Factors in People With Parkinson's Disease: A Large Prospective Cohort Study
The Relative Contribution of Physical and Cognitive Fall Risk Factors in People With Parkinson's Disease: A Large Prospective Cohort Study
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DOI：
10.1177/1545968313508470
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发表时间：
2014-03-01
影响因子：
4.2
通讯作者：
Lord, Stephen R.
中科院分区：
文献类型：
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作者：
Paul, Serene S.;Sherrington, Catherine;Lord, Stephen R.
背景。为了为帕金森病 (PD) 患者制定多方面的跌倒预防策略，需要更好地了解身体和认知表现对跌倒的影响。客观的。我们的目的是确定一系列全面的身体和认知风险因素对前瞻性测量的大量帕金森病患者跌倒的相对贡献，并为该群体开发一个解释性多变量跌倒风险模型。方法。研究人员收集了 205 名社区居住的帕金森病患者的帕金森病体征和症状、步态冻结、平衡、活动能力、本体感觉、腿部肌肉力量和认知的测量结果。使用跌倒日记对跌倒情况进行了为期 6 个月的前瞻性监测。结果。随访期间共有 120 名参与者（59%）跌倒。在单变量分析中，步态冻结 (P < .001)、运动障碍 (P = .02)、预期和反应平衡受损 (P < .001)、认知受损 (P = .002)、腿部肌肉力量减弱 (P = .006) 和本体感觉减弱 (P = .04) 与未来跌倒显着相关。步态冻结（风险比 [RR] = 1.03，95% 置信区间 [CI] = 1.00-1.05，P = .02），预期受损（RR = 1.01，95% CI = 1.00-1.02，P =.03）和反应性（RR = 1.26，95% CI = 1.01-1.58，P = .04) 平衡和定向障碍 (RR = 1.28, 95% CI = 1.01-1.62, P = .04) 在多变量分析中与跌倒保持显着关联。结论。研究结果阐明了帕金森病患者跌倒的重要身体和认知决定因素，并可能有助于为这一高危人群制定有效的跌倒预防策略。
Background. In order to develop multifaceted fall prevention strategies for people with Parkinson's disease (PD), greater understanding of the impact of physical and cognitive performance on falls is required. Objective. We aimed to identify the relative contribution of a comprehensive range of physical and cognitive risk factors to prospectively-measured falls in a large sample of people with PD and develop an explanatory multivariate fall risk model in this group. Methods. Measures of PD signs and symptoms, freezing of gait, balance, mobility, proprioception, leg muscle strength, and cognition were collected on 205 community-dwelling people with PD. Falls were monitored prospectively for 6 months using falls diaries. Results. A total of 120 participants (59%) fell during follow-up. Freezing of gait (P < .001), dyskinesia (P = .02), impaired anticipatory and reactive balance (P < .001), impaired cognition (P = .002), reduced leg muscle strength (P = .006), and reduced proprioception (P = .04) were significantly associated with future falls in univariate analyses. Freezing of gait (risk ratio [RR] = 1.03, 95% confidence interval [CI] = 1.00-1.05, P = .02), impaired anticipatory (RR = 1.01, 95% CI = 1.00-1.02, P =.03) and reactive (RR = 1.26, 95% CI = 1.01-1.58, P = .04) balance, and impaired orientation (RR = 1.28, 95% CI = 1.01-1.62, P = .04) maintained significant associations with falls in multivariate analysis. Conclusion. The study findings elucidate important physical and cognitive determinants of falls in people with PD and may assist in developing efficacious fall prevention strategies for this high-risk group.