Citation

Romagnolo A, Zibetti M, Merola A, Canova D, Sarchioto M, Montanaro E, Artusi CA, Vallelonga F, Maule S, Lopiano L. J. Neurol. 2019; 266(1): 85-91.

Affiliation

Department of Neuroscience Rita Levi Montalcini, University of Turin, via Cherasco 15, 10124, Torino, Italy.

Copyright

(Copyright © 2019, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00415-018-9104-4

PMID

30382389

Abstract

BACKGROUND: Falls represent one of the main complications of Parkinson's disease (PD), significantly lowering quality of life. Cardiovascular autonomic neuropathy (cAN) is one of the key contributing factors to PD-associated falls. However, a direct quantification of its impact on the risk of falling in PD is still lacking. In this 12-month prospective study, we sought to evaluate the association between cAN and falls.

METHODS: Fifty consecutive patients were evaluated with a standardized battery of autonomic testing, Unified Parkinson's Disease Rating Scale, push and release (P&R) test, timed up and go test, freezing of gait (FOG) questionnaire, Montreal cognitive assessment (MoCA). Dyskinesia severity and presence of REM sleep behavioral disorder (RBD) were additionally considered. Patients were followed-up for 12 months.

RESULTS: We observed a 38% prevalence of cAN. At baseline, 36% of patients reported at least one fall in the previous 6 months. This figure increased to 56% over the follow-up. After adjusting for age, disease duration, axial symptoms, MoCA and dopaminergic treatment, cAN was significantly associated with a 15-fold (OR 15.194) higher probability of falls; orthostatic hypotension (OH), the most common expression of cAN, with a 10-fold probability (OR 10.702). In addition P&R test (OR 14.021), RBD (OR 5.470) and FOG (OR 1.450) were independently associated with greater probability of falls.

CONCLUSIONS: cAN, including but not limited to OH, is a strong independent predictor of falls in PD. Future research endeavors clarifying to what extent pharmacological and non-pharmacological treatments targeting autonomic dysfunctions might reduce the risk of falls are warranted.

Language: en

Keywords

Autonomic neuropathy; Falls; Orthostatic hypotension; Parkinson disease; RBD