Analysis of causes for falls in people with Parkinson's disease

Abstract

Falls in Parkinson's disease may pose a significant threat for patients. This is not only a clinical problem, but also an economic one. The effects of falls may cause deterioration of the quality of life for both patients and their caretakers. The causes of falls are not clinically uniform: the falls are caused by various factors and require a differential diagnosis. The purpose of this paper is to analyse the above mentioned causes, as well as to draw clinicians' attention to the possibility of effective therapy for certain disorders that cause such falls in patients with Parkinson's disease. 51 patients with recognized Parkinson's disease were examined, including 25 persons who reported falls that had occurred within the past 6 months and 26 persons who had no falls. In both groups there were patients with different types of the disease (tremulous, akinetic-hipertonic and mixed). The clinical status of the patients was assessed using the Hoehn and Yahr scale. In each patient Schellong test and EEG examinations were performed. It has been established that the occurrence of falls is related to the duration of the disease (on average 9.6 years in the group with falls versus 6.2 years in the group without falls) and the daily levodopa dosage (on average 806.0 mg in the group with falls versus 499.0 mg in the group without falls). The proportion of patients with abnormalities in the EEG (revealed mainly as slowing of EEG background activity) was notably higher in the group with falls. The comparison of such groups from the point of view of sex, age, stage of the disease and the occurrence of asymptomatic orthostatic hypotension did not reveal any statistically significant differences. The analysis of the causes of falls in the examined patients revealed that in 8 cases they fell due to unstable posture, 4--due to freezing or festination, 1--due to symptomatic orthostatic hypotension, 1--due to co-existing neurological disorders, 2--due to the heart arrhythmia (requiring implantation of pacemaker), in 8 persons--due to toppling falls and in 1 patients the falls could not be classified.