A three-year longitudinal study of the incidence and clinical features of falls in patients with Parkinson’s disease

Objective To determine the incidence and features of falls in patients with Parkinson’s disease (PD) and to investigate the risk factors of falls through a 3 years follow-up. Methods We divided 92 PD patients into 2 groups: the faller group （Unified Parkinson’s Disease Rating Scale(UPDRS)-13≥2) and non faller group (UPDRS-13=0）, using the UPDRS-13 item. All patients were assessed by UPDRS, Hoehn-Yahr (H&Y) stage, Minimum Mental Stage Examination (MMSE), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and were enquired the presence of hallucination at baseline and followed for 3 years. Results （1）The incidence of falls rose from 14.13% (13/92) at baseline to 32.18%(28/87) after 3 years. The rate of drop-out was 5.43% (5/92). （2）At baseline，in terms of motor symptoms, the faller group was dominated by the subtype of non-tremor (9/13 vs 22/60; χ2=4.64，P=0.003) and longer duration((7.15±3.87) vs (4.12±2.75) years; t=－3.34，P=0.001), higher HY χ2=9.26，P=0.002), higher scores of UPDRS (43.85±16.57 vs 31.88±15.23; t=－2.53，P=0.010) and UPDRS-Ⅱ(15.31±6.79 vs 8.33±4.48; t=－4.61，P=0.000), higher incidence of motor fluctuation (8/13 vs 15/60; χ2=6.17, P=0.010) and dysarthria (9/13 vs 4/60; χ2=22.96, P=0.000). （3） At baseline，in terms of non-motor symptoms, the faller group was dominated by higher scores of HAMA (12.15±6.03 vs 7.95±4.73; t=－2.75, P=0.008) and HAMD (20.08±8.64 vs 11.12±5.67; t=-4.67，P=0.000), higher incidence of hallucination (6/13 vs 9/60; χ2=65.48，P=0.020) and lower scores of MMSE (20.62±5.06 vs 23.64±4.50; t=2.14，P=0.040). （4） Non-tremor subtype (OR=370.79, 95%CI 2.97—462.10, P=0.016) and levodopa equivalent dosage (OR=1.01, 95%CI 1.00—1.02, P=0.030) were the independent risk factors of falls in patients with PD. Conclusions The incidence of falls significantly increases as the disease progresses. PD patients with a history of falls have a tendency to suffer from more serious motor and non motor symptoms. The non-tremor subtype and levodopa equivalent dosage are associated with falls in patients with PD. Key words: Parkinson disease; Accidental falls; Incidence; Risk factors