EARLY FALLS RISK DETECTION IN PEOPLE WITH PARKINSON DISEASE AT THE HOEHN-YAHR STAGE II

S. Gomez Argüello^1,2, D.H. Verdecchia^1,2, N. Greco³, M. Ostolaza², T. Arakaki^4,5

Background: People with Parkinson's disease (PWP) develop falls and postural instability and it adversely affects their gait and quality of life. In advanced stages, the falls could reach a high prevalence. However there is some conflict to know when a PWP will begin to fall. The “Movement Disorder Society-Unified Parkinson Diseases Rating Scale” (MDS-UPDRS III) includes the pull test to evaluate different degrees of postural instability. However, this does not present a high association with postural stability measured by the most objective and valid balance assessments. Therefore the pull test could not necessarily correlate with the history of falls or with a tendency to lose balance. The Timed Up and Go Test (TUG) and posturography have been used to assess the risk of falls in PWP. Posturography is useful to determine the limits of stability and the delays in reaction times (RT). The longer RT is an indicator of risk of falls in this population. Therefore, the combination of posturography and TUG could be helpful to establish postural instability or risk of falls in PWP with a negative pull test.

Purpose: Estimate the association between Timed Up and Go Test and reaction times composite in people whit Parkinson's disease stage Hoehn & Yahr II to identify early the risk of falls.

Methods: PWP and controls performed the TUG at comfortable (TUGc) and maximum speed (TUGm). RT composite (RTC) was measured with Balance Master® (Neurocom, Clackmas, OR, U.S.A.). Mean and interquartile range were used to describe the outcome measures. Mann-Whitney U test was used for groups comparisons. The Spearman's rho correlation coefficient was used for the association between TUG and RT composite.
The study was approved by the Maimonides University Ethical Committee and was performed in accordance with the ethical standards laid down Declaration of Helsinki and its later amendments.

Results: Twenty-three PWP and 19 controls were included. The mean age showed that controls were 8 years older than the PWP group and the majority were men in both groups. The disease duration was 7 years (IQR 2.75-10) with mean MDS-UPDRS III of 27.1 (±12). The Mini-mental test was similar in both groups. The PWP presented risk of falls TUGc: 10.9s (9-12), controls did not. The TUGm in PWP was 7.9s (7-9) versus controls TUGm: 6.66s (6-8), p=0.01. The PWP had higher RTC: 1.06s (0.8-1.17) than controls: 0.81s (0.7-1.06), p=0.04. Furthermore, in PWP correlation between the RTC and both TUG where higher than controls the RTC, (TUGc vs RTC in PWP rho=0.49 vs. controls rho=0.24; TUGm vs RTC in PWP rho=0.55 vs controls rho=0.08).

Conclusion(s): These results suggest that TUG and RTC could be useful tests to identify subclinical risk of falls in PWP stage Hoehn & Yahr II, which could not be detected using the MDS-UPDRS III alone.

Implications: These results could be helpful to identify PWP with risk of falls and make enable an early intervention. Furthermore, the TUG is a quick administered tool and easily reproducible in clinical practice.

Funding, acknowledgements: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Keywords: Parkinson's disease, Falls risk, pull test

Topic: Neurology: Parkinson's disease

Did this work require ethics approval? Yes

Institution: Universidad Maimonides

Committee: Comité de Ética de la Investigación de la Universidad Maimónides

Ethics number: CEI/2016/004