Falls in persons with Parkinson's disease: Do non-motor symptoms matter as much as motor symptoms?

ABSTRACT Falls are common among persons with Parkinson's disease (PD). On the other hand, predicting falls is complex as there are both generic and PD-specific contributors. In particular, the role of non-motor symptoms has been less studied. Objective: The objective of this study was to identify the role of non-motor predictors of falling in persons with PD (PwP). Methods: A cross-sectional study was carried out in PwP recruited from a movement disorders clinic. Clinical and demographical data were collected. All PwP were assessed using the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and the Non-Motor Symptoms Scale (NMSS). Variables were assessed at the bivariate level. Significant variables were put into a logistic regression model. Results: A total of 179 PwP were included. Overall, 16.8% of PwP had fallen in the past 12 months, with 53.3% of them being recurrent fallers. The mean number of monthly falls was 2.5 ± 3.3. Factors associated with falling in the bivariate analysis included the disease duration, Hoehn and Yahr stage, MDS-UPDRS part I and II, postural instability/gait disturbance (PIGD) subtype, NMSS urinary domain, NMSS miscellaneous domain, and non-motor severity burden (all p-values < 0.05). After multivariate analysis, only the disease duration (p = 0.03) and PIGD (p = 0.03) remained as independent risk factors. Conclusion: Disease duration and the PIGD subtype were identified as relevant risk factors for falls in PwP Non-motor symptoms appear to have a less important role as risk factors for falls.

摘要
跌倒在帕金森病（Parkinson's Disease, PD）患者中十分常见。另一方面，跌倒预测颇具复杂性，因其诱因既包含通用风险因素，也存在帕金森病特异性致病因素。尤为值得注意的是，非运动症状在跌倒预测中的作用尚未得到充分研究。
目的：本研究旨在明确帕金森病患者（Persons with PD, PwP）中非运动症状作为跌倒预测因子的作用。
方法：本研究为横断面研究，研究对象为从运动障碍门诊招募的帕金森病患者。研究收集了受试者的临床与人口统计学资料。所有受试者均采用运动障碍学会统一帕金森病评定量表（Movement Disorders Society Unified Parkinson's Disease Rating Scale, MDS-UPDRS）以及非运动症状量表（Non-Motor Symptoms Scale, NMSS）进行评估。采用双变量分析对各变量进行评估，将具有统计学意义的变量纳入逻辑回归模型进行分析。
结果：本研究共纳入179名帕金森病患者。整体而言，16.8%的受试者在过去12个月内发生过跌倒，其中53.3%为复发性跌倒者。受试者的平均月跌倒次数为2.5±3.3次。双变量分析显示，与跌倒相关的因素包括病程、Hoehn-Yahr分期、运动障碍学会统一帕金森病评定量表第一、二部分评分、姿势不稳/步态障碍（Postural Instability/Gait Disturbance, PIGD）亚型、非运动症状量表泌尿系统维度评分、非运动症状量表其他维度评分以及非运动症状严重负荷度（所有p值均<0.05）。经多变量分析后，仅病程（p=0.03）与PIGD亚型（p=0.03）仍为独立危险因素。
结论：本研究确认，病程与PIGD亚型是帕金森病患者跌倒的相关危险因素；而非运动症状作为跌倒危险因素的作用相对较弱。