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Balance Issues Are Inevitable with Parkinson’s Disease

balance

Years ago, Harrison Ford played the role of Henry Turner, the main character in the movie “Regarding Henry.”

Henry’s entire world shifts when he is shot in the head during a robbery at the convenience store where he was buying cigarettes. The nearly fatal injury puts him into cardiac arrest and he ends up with brain damage, specifically retrograde amnesia.

It takes several months for Henry to recover. When he is finally released from the hospital, he is not the man he used to be — an arrogant playboy who steps on others to get what he wants. The Henry from before was unfaithful to his wife, and his daughter was afraid of him. Henry post-injury is almost childlike, and upon learning who he was before the accident, tries to right some of his wrongs.

In the first few days home, Henry is sitting at the table with his daughter eating breakfast when she accidentally spills her milk on the kitchen table. Fear seizes her as she awaits Henry’s reaction. He sees the fear in her eyes, and to put her at ease, says, “It’s OK. I do that all the time.” He then tips over his glass of milk as well.

A few months ago, I read about a woman who had Parkinson’s disease (PD). She, like so many of us, was frequently dropping things, including her meals, which made her feel humiliated and embarrassed. Unfortunately, that’s what PD does. It gives you plenty of opportunities to be humiliated and embarrassed, always when you least expect it. But what we need to do is learn to go easy on ourselves. It’s not like we are doing these things on purpose.

The fact is that we all spill things, Parkinson’s or not. We all lose our balance and drop things or fall to the ground. Having PD just makes the opportunities more probable. We need to recognize that spills and falls are going to happen sooner or later, and we should try to be ready for it.

Here’s what you will need:

  • A cane or a walker
  • A helmet
  • Knee pads
  • Body armor
  • Elbow pads
  • Shin guards
  • Safety goggles
  • Leather gloves
  • Steel-toe boots
  • Brawny paper towels for those tough spills
  • Medic alert device to alert people that you have fallen and can’t get up
  • A sense of humor

A dog to lick up those spills wouldn’t be bad, either. Just decide that you are going to turn that 5-second rule into 20 — as we all know, things take just a little bit longer to do with PD!

***

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

The post Balance Issues Are Inevitable with Parkinson’s Disease appeared first on Parkinson’s News Today.

Low Vitamin D Levels Linked to Added Falls, More Sleep Problems, Depression, Study Shows

low Vitamin D

Low vitamin D levels are associated with a greater tendency for falls, sleep problems, anxiety, and depression in people with Parkinson’s disease, according to a recent study.

The findings, “Relationship between 25‐Hydroxyvitamin D, bone density, and Parkinson’s disease symptoms,” were published in the journal Acta Neurologica Scandinavia.

Vitamin D deficiency and low bone mass are frequently observed in people with Parkinson’s disease (PD). In fact, one particular study found that lack of this vitamin is more common in people with Parkinson’s (55% of patients) than other populations, such as people with Alzheimer’s disease (41% of patients).

But the relationship between vitamin D levels and Parkinson’s has remained controversial. Some studies suggest that taking vitamin D3 — a form of vitamin D used in supplements — can stabilize the disease, while others see no relation with the risk of Parkinson’s.

However, most studies have focused on limited aspects of the disease and did not include important outcomes — notably, non‐motor symptoms.

Vitamin D has a vital role in bone health, since it promotes calcium absorption and bone mineralization, which keeps bones strong and healthy. It also blocks the release of parathyroid hormone (PTH), an hormone that promotes bone tissue reabsorption and bone thinning.

Some studies support that lack of vitamin D results in a greater risk of falls and fractures in Parkinson’s patients, which can increase hospitalization and even fatal disability. Its levels also have been associated with cognition and mood, as well as stomach malfunction, in people with the disease.

While it is possible that deficits in this vitamin impact several symptoms of PD, the connection remains unclear.

To shed light on this relationship, researchers at the Second Affiliated Hospital of Soochow University and Soochow University, in China, set out to determine if vitamin D levels correlated with bone mineral density (BMD) and non‐motor symptoms in Parkinson’s patients.

The team measured blood levels of 25-hydroxyvitamin D, or 25(OH)D — a precursor of the active form of vitamin D and the most accurate indicator of vitamin D levels in the body — and performed extensive clinical evaluations in 182 Parkinson’s patients as well as 185 healthy people (controls).

Participants were recruited from the Second Affiliated Hospital of Soochow University from March 2014 to December 2017.

Bone mineral density — a measure of bone mass and health — was measured at the lumbar spine and the top of the femur (thigh bone) by bone densiometry, which measures bone loss.

The data showed that people with Parkinson’s had significantly lower vitamin D levels in the blood compared with healthy controls — an average of 49.75 versus 43.40 nanomol per liter of 25(OH)D.

In agreement, low levels of vitamin D (below 50 nmol/l) also were more common in Parkinson’s patients (68.68%) than controls (54.05%).

People with lower vitamin D levels were more likely to fall and experience sleep problems, including difficulty in falling asleep (insomnia). They also had significantly more depression and anxiety.

Mean bone densities in both the spine and femur were lower in PD patients, however no correlation was seen between the levels of BMD and vitamin D.

“Together, these results indicate that vitamin D deficiency may play a role in PD pathogenesis [disease manifestations], while vitamin D supplementation may be used to treat the non‐motor symptoms of PD,” the researchers  said.

“As various non-motor symptoms place a burden on individuals with Parkinson’s disease and their caregivers, vitamin D might be a potential add-on therapy for improving these neglected symptoms,” study’s senior author Chun Feng Liu, MD, PhD, said in a press release.

However, the researchers stressed that future studies with a larger sample size are necessary to clarify the role of vitamin D in Parkinson’s disease.

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Trunk Exercises May Improve Balance in Parkinson’s Disease, Study Finds

Falls and Parkinson's

Exercise and fall prevention education can improve front-to-back trunk mobility in Parkinson’s patients with a history of falls, according to a Phase 2 clinical trial.

The study, “Trunk exercises improve gait symmetry in Parkinson disease: A blind phase II randomized-controlled trial” was published in the American Journal of Physical Medicine & Rehabilitation.

People with Parkinson’s disease are twice as likely to fall as those with other neurological disorders. Previous studies suggest that Parkinson’s patients underestimate the muscle work needed to produce a certain movement.  This lack of motor and perceptual ability leads them to adopt distinct postural strategies to keep their balance, both during static and dynamic movements.

Studies have associated falls to deficits in step-to-step symmetry and trunk muscle function.

Although antiparkinsonian medications can help control Parkinson’s motor symptoms as the disease progresses, patients typically need to gradually increase the treatment dose for maximum benefit. Even after increasing the dose, they might sometimes experience a reappearance or worsening of symptoms due to the diminishing effects of the therapy.

Therefore, there is a need for non-pharmacological therapies that alleviate patients’ motor symptoms and improve their quality of life.

Australian Catholic University researchers set up to investigate whether an exercise program geared to improving the strength and endurance of the trunk muscles could improve standing and walking balance in those with Parkinson’s disease.

The Phase 2 study (ACTRN12613001175763), evaluated 22 Parkinson’s patients (15 men and seven women, mean age 65.4 years) with a history of falls who were randomly assigned to either 12-weeks of exercise and fall prevention education (11 participants) or fall prevention education alone (11 participants).

For the exercise intervention, patients had to attend a supervised 90-minute training session once a week for 12 weeks. Each session was conducted in groups of up to three subjects.

“In short, the exercise-based intervention comprised three parts; i) a warm-up focusing on trunk mobility exercises to improve range of motion; ii) an exercise routine focusing on the endurance and stability of the trunk muscles …; and iii) a cool-down involving stretching and walking in a real-world environment,” researchers stated.

The exercise group also received health advice (same as the education-only group), in the form of weekly educational brochures, aimed at preventing falls.

Participants in the education-only group were encouraged to continue their day-to-day lives, but received a weekly multidisciplinary health tip for 12 weeks that explained how exercise, nutrition and/or sleep quality could influence their fall risk and quality of life.

Initial assessment showed that there were no differences in cognition, vision, neurological function and mobility between study groups. Nonetheless, the exercise sample had a greater body mass index (measure of body fat based on height and weight) compared to the education-only group.

Twelve and 24 weeks after initial assessment, investigators examined patients’ symptom severity, balance confidence, mobility and quality of life.

All 22 patients were reassessed at 12 weeks, but four subjects (two in the exercise group and two in the education-only group) did not complete the 24-week follow-up.

At 12 weeks, the exercise sample had significant and clinically relevant improvements in front-to-back step-to-step symmetry of head and trunk movements, meaning these patients might be able to balance themselves more easily. The exercise group also had improved trunk muscle function.

The education-only group also had significant and clinically relevant improvements but in side-to-side and vertical step-to-step trunk symmetry, as measured by the harmonic ratio — a mathematical analysis of trunk acceleration used to measure walking smoothness, walking rhythmicity, or dynamic stability.

Step-to-step symmetry remained unchanged from the 12- to the 24-week evaluation in the exercise group. “The lack of significant changes in step-to-step symmetry between the 12- and 24-week assessments for the exercise group also suggests that the benefits of the weekly exercise program may be retained for up to 12 weeks following the cessation of the training regimen,” researchers said.

Regarding the education-only sample, their reduced step-to-step trunk symmetry at 12 weeks had almost been restored to initial assessment (baseline) values at 24 weeks.

These results indicate that torso-specific exercises may improve (or at the very least, maintain) trunk mobility in Parkinson’s patients and that measures of step-to-step symmetry, such as the harmonic ratio, could be used to assess subtle changes in postural control.

“Given the encouraging outcomes of this study, future research might seek to establish whether increasing the frequency of this exercise program offers greater improvements in step-to-step symmetry and/or has the potential to reduce the rate of falls in people with [Parkinson’s disease],” researchers said.

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Changes in Neuronal Communication Linked to Falls and Freezing of Gait in Parkinson’s, Study Finds

neuronal communication changes, Parkinson's motor symptoms

Parkinson’s disease-related falls and freezing of gait — when patients are unable to move their feet forward when trying to walk — are associated with changes in a specific type of neuronal communication in different brain regions, a study reports.

The study, “Cholinergic system changes of falls and freezing of gait in Parkinson disease,” was published in Annals of Neurology.

Many people with Parkinson’s disease will experience falling and freezing of gait, which tend to become more frequent as the disease progresses. In some cases, symptoms cannot be controlled with dopaminergic therapy, suggesting that non-dopamine mechanisms contribute to Parkinson’s disease motor symptoms.

Previous studies have shown that the brainstem (region that connects the brain to the spinal cord) and basal forebrain (important in the production of acetylcholine) regions with degenerated acetylcholine-releasing neurons projecting to the thalamus and cerebral cortex are associated with falls and slow gait speed in Parkinson’s patients.

Acetylcholine is a brain chemical (neurotransmitter) released by nerve cells to send signals to other cells (neurons, muscles, and glands). The thalamus is involved in several important processes, including consciousness, sleep, and sensory interpretation; the cerebral cortex plays a key role in memory, attention, perception, awareness, thought, language, and consciousness.

Scientists have also observed reduced dopaminergic nerve terminals in the striatum, reduced cholinergic (meaning “acetylcholine-releasing”) nerve terminals in the cortex, and more severe beta-amyloid accumulation in Parkinson’s disease “freezers” compared with “non-freezers.”

The striatum coordinates multiple aspects of cognition, including both motor and action planning; the cholinergic system contains nerve cells that use acetylcholine to propagate a nerve impulse, and has been associated with a number of cognitive functions, including memory, selective attention, and emotional processing.

University of Michigan researchers hypothesized that distinct patterns of cholinergic projection system changes in the brain are associated with freezing of gait and falls in Parkinson’s patients.

The team examined and performed [18F]FEOBV positron emission tomography (PET) scans on 94 Parkinson’s patients (72 men and 22 women) with a history of falling and “freezing.” Most subjects were taking dopamine agonists, carbidopa-levodopa or combinations of both.

[18F]FEOBV is a radioactive marker that selectively binds to the vesicular acetylcholine transporter (VACht) that loads acetylcholine into synaptic vesicles — sac-like structures in neurons that store chemical messengers before releasing them into the gap between nerve cells (synapse), enabling neuronal communication.

A PET scan is a non-invasive imaging technique to visualize metabolic processes in the body. Before the scan, [18F]FEOBV is administered via injection; doctors wait for the radiotracer to be distributed throughout the body, and then scan the patient to detect and quantify the patterns of its accumulation in the body.

Because the marker binds to VACht, scientists use it to quantify active cholinergic nerve terminals in the brain.

“Participants were asked about a history of falling. A fall was defined as an unexpected event during which a person falls to the ground. The presence or absence of (freezing of gait) was based on clinical examination and directly observed by the clinician examiner,” according to The Movement-Disorder Society Sponsored-Unified Parkinson’s Disease Rating Scale (MDSUPDRS), the researchers wrote.

They reported that 35 participants (37.2%) had a history of falls, and 15 (16%) had observed freezing of gait.

Compared with non-fallers, fallers had a significant decrease in VACht expression within the right thalamus, specifically in the lateral geniculate nucleus, which is the primary center for processing visual information. This suggests that the visual information processing required for walking around safely might be compromised in Parkinson’s patients with a history of falling.

On the other hand, patients with freezing of gait had significantly reduced VACht expression in the bilateral striatum and hippocampus — required for learning and memory — compared with non-freezers.

The team found that a history of falls was associated with cholinergic projection system changes that relay to the thalamus, while the neural signals behind freezing of gait transmit to the caudate nucleus — a brain region associated with motor processing.

They also found that Parkinson’s fallers had a lower density of thalamic cholinergic nerve terminals compared with non-fallers.

Freezing of gait was related to longer disease duration, more severe parkinsonian motor ratings, and higher levodopa levels.

These results suggest that changes in acetylcholine-mediated neuronal communication are linked to falls or freezing behavior, depending on the affected brain region.

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Vitamin D May Improve Balance in Younger Parkinson’s Patients, Pilot Study Suggests

Short-term supplementation of vitamin D in high doses may improve balance in people with Parkinson’s disease younger than 66, according to results of a Phase 2 pilot study.
The study, “A randomized, controlled pilot study of the effects of vitamin D supplementation on balance in Parkinson’s disease: Does age matter?” was published in Plos One.
Parkinson’s patients are at a high risk of falling mainly due to problems with balance — one of the primary symptoms of the disease. It is estimated that 70 percent of Parkinson’s patients fall at least once a year.
Falls are associated with substantial injury, disability, hospitalization, and reduced quality of life in Parkinson’s patients and in older people in general. However, no pharmaceutical or surgical intervention is currently known to significantly improve balance.
As a result, there is an unmet need to discover or develop therapeutic approaches to improve balance in Parkinson’s patients.
At the same time, individuals with Parkinson’s, particularly those with advanced disease, have lower levels of vitamin D, which is involved not only in bone health, but also in brain function.
Previous studies have shown that vitamin D supplementation reduces fall rates and improves balance in older people. While it has been suggested that higher doses of vitamin D are more effective than lower ones, more recent evidence suggests that higher doses in older populations may have the opposite effect, being associated with more frequent falls and fractures.
A randomized, double-blinded, placebo-controlled Phase 2 pilot study (NCT01119131) evaluated the safety and effectiveness of high-dose vitamin D supplementation on balance, gait, falls, strength, and cognition in Parkinson’s patients. Disease severity and quality of life were also assessed.
Researchers analyzed the data of 51 patients, at a mean age of 66.57 years, who were randomized to receive either a high dose of vitamin D (27 patients) or a placebo (24 patients), in addition to 1,000 mg of calcium, daily for four months.
Balance function was measured using the Sensory Organization Test (SOT), an objective test to measure impairments in postural stability or balance, which has been found to be the most suitable for assessing balance in relation to vitamin D levels.
Results showed that vitamin D supplementation doubled patients’ vitamin D blood levels after four months of treatment, while patients who received placebo showed no substantial changes in their levels.
Patients receiving the high dose of the supplement showed no significant improvements in balance, compared with those in the placebo group. In addition, no significant changes were found for gait, strength, cognition, disease severity, or quality of life between the two groups of patients.
However, when researchers divided the patients who received vitamin D into two age groups — those 66 or younger, and those 67 and older — the supplement was found to significantly improve the balance of patients in the younger group, compared with the older age group. No significant therapeutic effect of the supplement was found for any of the other measures.
High-dose vitamin D supplementation appeared to be safe, with no serious adverse events reported.
These findings highlight the possibility of an “age-dependent role for vitamin

Source: Parkinson's News Today

Parkinson’s Patients with Tendency to Fall Control Balance Differently than Non-Fallers, Study Suggests

Parkinson's fall risk

Parkinson’s disease patients who have a tendency to fall use different strategies to control their balance than those who do not fall, according to a recent study.

The study, “Fallers with Parkinson’s disease exhibit restrictive trunk control during walking,” was published in Gait and Posture.

Due to Parkinson’s-related motor imbalance, falls are a common consequence of the disease, and the risk of falling increases as patients get older and as the disease progresses.

Parkinson’s patients are twice as likely to fall than older adults living independently, and are also nine times more likely to have recurrent falls.

Observational studies suggest these patients underestimate the amount of work necessary for their muscles to produce a certain movement. They compensate for this lack of motor and perceptual ability by adopting distinct postural strategies to keep their balance during both static and dynamic movements.

Static measures of posture control can distinguish Parkinson’s patients from healthy older adults, but not Parkinson’s fallers from non-fallers.

“A better understanding of the relationship between falls and static and dynamic movements may provide further insight into falls-risk assessment in this clinical population,” the researchers said.

To study this, researchers at the University of Ottawa in Canada conducted a study that recruited 25 Parkinson’s patients and 17 healthy older adults used as controls.

They analyzed postural differences between Parkinson’s fallers and non-fallers, based on the self-reported occurrence of falls in the previous three months, and between healthy controls.

Motor disability was measured using the Unified Parkinson’s Disease Rating Scale III, cognitive impairment by the Montreal Cognitive Assessment, and freezing of gait by the Freezing of Gait questionnaire.

Participants were given static and dynamic motor tasks, consisting of one quiet standing condition and one walking condition (walking 15 meters while looking straight ahead).

Both tasks were presented twice and lasted for 30 seconds. Testing was performed while patients were optimally medicated with dopaminergic therapies.

The standing test was sensitive enough to distinguish between Parkinson’s patients and healthy controls, but not between fallers and non-fallers with Parkinson’s disease. However, static tasks were less sensitive in differentiating between fallers and non-fallers with Parkinson’s disease and healthy older adults than dynamic tasks.

Fallers had difficulty controlling their upper body (torso) when walking, compared with non-fallers and the control group. This was also true for individuals with Parkinson’s disease versus older healthy adults.

Importantly, falling was associated with static and dynamic postural control in Parkinson’s patients, with fallers and non-fallers adopting different postural strategies to regulate balance.

“Overall, this study provides useful information for falls-risk assessments as well as for developing fall prevention program specific to fallers and non-fallers with PD,” the researchers concluded.

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Source: Parkinson's News Today

Beat It! Learning to Walk to Music Reduces Falls for Parkinson’s Patients

walking and music

A training program in which patients walk while listening to regular beats can improve the velocity and cadence of Parkinson’s disease patients, while reducing their risk of falling, a study shows.

The study, “Rhythmic auditory stimulation for reduction of falls in Parkinson’s disease: a randomized controlled study,” was published in the journal Clinical Rehabilitation.

Parkinson’s disease patients experience difficulties in movement that affect their ability to produce a steady gait, resulting in a high incidence of falls. More than half of all Parkinson’s patients fall recurrently.

While there are several training techniques to aid in maintaining a steady gait and avoiding falls, studies suggest that gait motor control is dependent on a patient’s internal timing and that rhythm-based training could reduce risk of falling.

The rhythmic auditory stimulation (RAS) technique is among the approaches used to synchronize gait movements with time cues. But there have been no studies assessing the benefits of RAS in Parkinson’s patients.

So, researchers in Canada set out to determine if a home-based RAS program could aid in decreasing falls in patients with that history.

The study was a randomized, controlled trial (NCT03316365) that involved 60 Parkinson’s patients, 47 of whom completed the study.

The RAS training protocol involved 30 minutes of daily walking using “click-embedded music,” which was designed to enhance rhythm perception. Essentially, patients listened to folk or classical music with embedded metronome beats while performing their walking exercises.

Participants were divided into two groups, experimental and control. Both groups received RAS training up to week 8, after which the control group stopped training and the experimental group continued. Then  training was resumed for the control group between weeks 16 and 24. Patients in the experimental group received RAS training for the entire 24 weeks.

Participants were assessed at the beginning of the study and at eight, 16, and 24 weeks following that. Assessment criteria included stride length, speed, balance, and falls.

As expected, no significant differences were seen between the two groups at week eight. However, at week 16, the experimental group showed significant improvement in velocity, cadence, stride length, decreased number of falls, and fear of falling compared to the control group.

At week 24 — after the control group had resumed RAS training — the signifiant differences in velocity, cadence, stride length, and fear of falling remained, but there were no longer significant differences in the number of falls.

Taken together, the findings indicate that “RAS gait training significantly reduced the number of falls and modified key [parameters] in gait control in patients with Parkinson’s disease,” researchers wrote.

“This clinical investigation demonstrates that RAS gait training is a potential intervention to reduce the risk of falling, since it directly addresses temporal instability, which is one of the most detrimental variables associated with falls,” they concluded.

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Source: Parkinson's News Today

What is Parkinson’s Disease? This is Parkinson’s Disease

Little Monster

Sherri Journeying Through

My knees are shaking and it’s not from nervousness. This is Parkinson’s disease.

Stiff muscles abound throughout my aching body. This is Parkinson’s disease.

My lips quiver, my teeth click, smiles turn into frowns. This is Parkinson’s disease.

My toes and fingers bend involuntarily because … this is Parkinson’s disease.

My legs, my arms, my sides, my back, my stomach, they can all seize up in great twisting pain for … this is Parkinson’s disease.

My voice can falter and fade, and I shout when they yell at me to “speak up” because … this is Parkinson’s disease.

I choke on my food and swallowing is becoming harder. This is Parkinson’s disease.

I can trip, I can fall, I walk like a shuffling penguin. This is Parkinson’s disease.

Writing has become difficult and frustrating. What once was legible is now a Parkinson’s “scratch.”

The “Little Monster” is to blame for most of what is wrong with me because “Little Monster” is Parkinson’s disease, and Parkinson’s disease is “Little Monster.”

The good and the bad and the happy and the sad are both a blessing and a curse because … this is Parkinson’s disease.

On one side I am almost free, and on the other, I am bound in chains because … this is Parkinson’s disease.

Confusion and some irritability can be blamed on Parkinson’s. And why not? If I must bear this crazy disease, then I ask you … why not?

Why not blame it for being snappy and silly, for running into walls and tripping over chairs, and all things else like that?

Why not blame it for everything in life gone wrong? Seems fair. It took from my life what wasn’t its to take, and it just keeps taking and taking.

Am I angry? No. I hold no grudges about that which I cannot see, and though I can see God in this world around me, I do not blame Him. I do not see Him in this hideous disease, but I see Him more clearly because of it.

I see Him because by His comfort and His care and the way He loves me through this … this Parkinson’s disease. With His strong arms and His great, matchless mercy and relentless grace.

He is in the all — His faithfulness is trustworthy. It may be because of Parkinson’s that I may suffer, but it is with hope that I endure.

And it’s because of God I live joy unspeakable — in spite of this “Little Monster” I call … Parkinson’s disease.

***

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

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Source: Parkinson's News Today

Study Outlines Risk Factors for Frequent Falls in Parkinson’s Patients

frequent falls risk

Motor fluctuations, treatment with antidepressants, disease severity, and deep brain stimulation (DBS) are among the risk factors that contribute to frequent falls in patients with Parkinson’s, a large-scale study reports.

According to researchers, identifying predictors that put Parkinson’s patients at the greatest risk for falls can aid in early intervention to prevent these occurrences.

The study, “What predicts falls in Parkinson disease?” appeared in the journal Neurology: Clinical Practice.

Parkinson’s patients may experience falls as a result of their motor symptoms, such as uncontrollable accelerations, impaired balance, and freezing of gait. Approximately 50 percent of these falls require medical care.

Although a history of falling is considered the major risk factor for future falls, research reported that even individuals without any previous occurrences had a considerable risk of future falls. Other risk factors include disease stage and duration, older age, absence of tremor at rest, severity of motor impairment, cognitive dysfunction, taking antidepressants, and DBS — a surgical procedure to treat motor symptoms in Parkinson’s.

Recent studies also pinpointed dopaminergic treatment — intended to restore the reduced level of the neurotransmitter dopamine in Parkinson’s patients — disease severity, and gait characteristics, as well as clinical tests, as predictors of falls among patients without any previous history.

Researchers in this study analyzed longitudinal data from the National Parkinson Foundation Quality Improvement Initiative (NPF-QII) registry (NCT01629043) to discover what factors set apart Parkinson’s patients who are most likely to become frequent fallers.

The study included 3,795 participants from 19 NPF Centers of Excellence. A total of 3,276 (86.3%) patients reported no or rare falls in the three months prior to the first visit, of which 382 (11.7%) became frequent fallers by the annual follow-up visit. This rate is similar to those reported in prior studies, the researchers noted.

Predictors of falls included motor fluctuations, treatment with levodopa and antidepressants, DBS, reduced health-related quality of life, less than 90% of Parkinson’s diagnostic certainty, female sex, and worse semantic fluency (part of verbal fluency).

Another risk factor for falls was being a stage 2 or 3 on the Hoehn and Yahr scale — which is used to describe the progression of Parkinson’s symptoms, where stage 2 refers to bilateral involvement without impaired balance, and 3 to mild to moderate bilateral disease with postural instability but physical independence.

Regarding the association with antidepressants, the investigators said that although they are a known risk factor for falls in older adults and could indicate a greater incidence of depression — also a risk factor — clinicians should consider nonpharmacological alternatives to treat depression in Parkinson’s patients at risk of falling.

Between visits, factors contributing to conversion to “frequent faller status” included the addition of amantadine for involuntary muscle movements, a referral to occupational therapy, diagnoses of cancer or osteoarthritis, newly implemented DBS, and an increased need for social and hospital services, including more emergency visits, which may indicate poorer global health, the researchers said.

As for the correlation between DBS and the risk of falling, according to the authors, this finding is in line with evidence showing that postural instability and falls may worsen within the first year after surgery.

“We have identified a number of associations between disease characteristics, treatments, and comorbidities and emergent falls in [Parkinson’s],” they wrote. “Such identifiers may help target patient subgroups for falls prevention intervention.”

However, the scientists cautioned that although the analysis provides associations between risk factors and falls in Parkinson’s patients, it does not prove causality.

The NPF-QII registry is still recruiting participants for an estimated total of 10,000. It aims to identify the best expert care practices for improved outcomes, including survival and quality of life. The study is being conducted across the U.S., Canada, and in the Netherlands and Israel. More details on locations and contacts can be found here.

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Source: Parkinson's News Today

Socks with Sensors Being Tested to Detect Early Signs of Walking Disorders, Parkinson’s

ODU

Special socks using a wearable fitness-tracking technology are being investigated in a pilot study to see if they can detect early signs of movement or walking disorders, like Parkinson’s disease, or  in people.

Inspired by technology like Fitbit  — wearable equipment that track fitness performance like daily steps and heart rate — researchers at Old Dominion University in Virginia, working in collaboration with neurologists at Sentara Healthcare, are using washable socks wired with special sensors capable of tracking movement, detecting step numbers and gait patterns that might reveal clinical evidence of problems.

Developed Sensoria, these noncommercial fitness socks include a removable device capable of recording five to seven days’ worth of information, and sensors that can measure gait, acceleration and balance, according to a news story in  The Virginian-Pilot. Data is held in a small device attached to the socks, which can then be downloaded to a computer or sent to a smartphone or tablet.

A two-part pilot study is now underway in university students. If the data seem accurate, a second-part is planned involving 60 older adults — a mix of healthy people serving as controls and Parkinson’s patients, with both groups wearing the socks for seven days, the news article states.

“The ‘silver tsunami’ of older adults over the age of 65 is expected to double over the next 20 to 30 years,” Steven Morrison, an ODU professor and director of research for the School of Physical Therapy and Athletic Training, said in a university press release. “We are going to have more older adults at risk for falls, so anything we can do to decrease that risk will be better for the population as a whole.”

If all goes well, the researchers plan to reach out to Parkinson’s groups like the Michael J. Fox Foundation and  the National Institutes of Health (NIH) to support further studies into this fitness technology and its ability to detect problems before symptoms are evident, or a need for changes in treatment given someone with a disease diagnosis.

A YouTube video on this pilot study is available here.

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Source: Parkinson's News Today