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Research on falls in Parkinson's disease

Falling is a serious complication of Parkinson’s disease, affecting almost 70% of patients with this disease. We use scientific tests to examine why patients with Parkinson’s fall over. These tests involve investigating patients’ strength, speed, vision, sensation in the legs, balance while standing and safety while walking. We hope to identify ways in which falls might be reduced in patients. We also examine whether walking safety can be improved by auditory and visual methods.

Postural instability is a disabling complication of PD, leading to falls in up to 68% of patients with the disease. Among those with the disease, 13% fall more than once a week and 16% will experience a hip fracture within a year. As postural instability reduces both length and quality of life in PD, its pathophysiology needs to be examined. 

In order to understand the causes of falls in Parkinson’s disease, we are currently analyzing the results of a cohort study involving 110 patients with Parkinson’s whom we have followed for six to twelve months. We examined the following potential risk factors for falls: 

1. leg weakness,
2. slowed simple reaction times,
3. loss of sensation in the legs,
4. visual impairment, such as reduced visual acuity and contrast sensitivity,
5. cognitive impairment,
6. impaired standing balance,
7. impaired gait stability,
8. blood pressure abnormalities,
9. concomitant medical conditions,
10. use of medications, such as hypnotic, antidepressant, antipsychotic and antihypertensive drugs, and
11. level of exercise.

Gait stability was examined using triaxial, piezo-resistant accelerometers placed at the head and pelvis and measuring linear perturbations in vertical, anterior-posterior and medial-lateral planes while the subject walked at a constant gait speed. The perturbation or acceleration patterns were analysed using finite Fourier series to provide an overall estimate of gait rhythm and smoothness, namely the harmonic ratio.  

In addition, visual and auditory cues were used to determine if the gait of patients with Parkinson’s could be improved by simple, non-pharmacological techniques. Cognitive impairment in patients was examined by investigating how standing and walking can be affected by concomitant cognitive tasks. In order to obtain insights into the nature of postural instability, we used a range of vertical and leaning sway tests in Parkinson’s patients and healthy controls.   

We hope to provide models of Parkinson’s disease that can determine why groups of patients with the disease fall and predict which individuals are most likely to fall. Furthermore, we wish to document the impact of falls on the independence, quality of life, mood and mobility of patients with Parkinson’s disease.

Key researchers

Stephen Lord, Richard Fitzpatrick, Anne Tiedemann, Daina Sturnieks, Mark Latt