Relationship between mild cognitive impairment and falls in older people with and without Parkinson's disease: 1-Year Prospective Cohort Study
Relationship between mild cognitive impairment and falls in older people with and without Parkinson's disease: 1-Year Prospective Cohort Study
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DOI：
10.1016/j.gaitpost.2010.03.013
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发表时间：
2010-05-01
期刊：
影响因子：
2.4
通讯作者：
Majumdar, Sumit R.
中科院分区：
文献类型：
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作者：
Camicioli, Richard;Majumdar, Sumit R.
我们对102名无痴呆的老年人进行了为期12个月的纵向队列研究（52名帕金森病患者，50名年龄和性别匹配的对照组），以确定(1)轻度认知障碍是否可以预测患有或不患有PD的老年人的跌倒；(2)基线下降、冻结史和Hoehn和Yahr分期如何影响认知障碍与PD患者多次跌倒之间的关联。认知障碍定义为护理人员评定的临床痴呆评定量表（CCDRSum >0）上的损伤总和。总体而言，平均年龄（SD）为71.5（4.7）岁，42%为女性，26%已经下降，14%在基线时存在认知障碍。在12个月的随访中，31%（15/52）的PD患者和12%（6/50）的对照组出现了一次以上的下降，p = 0.04。当整个队列的2个预测因子模型相结合时，基线认知障碍患者跌倒的校正优势比（aOR: 4.8,95% Cl; 1.3-18.2）和既往跌倒（aOR: 7.4,95% Cl: 2.4-22.3）显著增加。该模型的总体准确率为82%，低灵敏度为19%，高特异性为99%。在PD亚组中，相同预测模型的总体准确率为79%，灵敏度为73%，但特异性较低，为81%。我们得出的结论是，轻度认知障碍可能会导致老年人跌倒风险超出常规风险因素，无论是否患有帕金森病。(C) 2010 Elsevier B.V.版权所有
We conducted a 12-month longitudinal cohort study of 102 older people without dementia (52 Parkinson's Disease 50 age- and sex-matched controls) to determine (1) if mild cognitive impairment predicts falls in older people with or without PD and (2) how baseline falls, a history of freezing and Hoehn and Yahr stage affected the association between cognitive impairment and multiple falls in PD patients. Cognitive impairment was defined as the sum of impairments on the caregiver-rated Clinical Dementia Rating Scale (CCDRSum > 0). Overall the mean age (SD) was 71.5 (4.7) years, 42% were women, 26% had fallen and 14% had cognitive impairment at baseline. Thirty-one percent (15/52)01 PD patients vs 12% (6/50) of controls fell more than once during 12-month follow-up, p = 0.04. When combined in a 2-predictor model for the entire cohort, the adjusted odds ratios [aOR] for falling were significantly increased for cognitive impairment at baseline (aOR: 4.8,95% Cl; 1.3-18.2) and prior falls (aOR: 7.4,95% Cl: 2.4-22.3). The overall accuracy of the model was 82%, with low sensitivity of 19% but high specificity of 99%. In the PD subgroup, the overall accuracy of the same prediction model was 79%, with much better sensitivity of 73% but a lower specificity of 81%. We conclude that mild cognitive impairment might contribute to falls risk beyond conventional risk factors in older people with and without PD. (C) 2010 Elsevier B.V. All rights reserved.