Amar K, Stack E, Fitton C, Ashburn A, Roberts H C
Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, UK.
University of Southampton, Faculty of Health Sciences, UK; NIHR CLAHRC Wessex, UK.
Parkinsonism Relat Disord. 2015 Jan;21(1):55-60. doi: 10.1016/j.parkreldis.2014.11.001. Epub 2014 Nov 12.
We compared fall frequency and prediction among People with Parkinson's Disease (PwP) with and without cognitive impairment (CI); researchers sometimes overlook the former, concerned about consent, recall and adherence and differences in fall frequency and predictability.
We recruited 101 PwP from one clinic, used the Montreal Cognitive Assessment to measure CI, noted repeated falls recalled retrospectively over 12 months and evaluated 'repeated falls' and 'difficulty turning' as predictors of falls over three months.
Participant median age was 76 years, and time since diagnosis 6 years. Of 40 participants without CI, 40% recalled falls and 55% fell during follow-up (1.9 (±3.8) falls/person), the sensitivity of fall history being 57% and of turning 36%. Of 36 participants with mild CI, 42% recalled falls and 42% fell during follow-up (1.2 (±1.8) falls/person), the sensitivity of fall history being 67% and of turning 69%. Of 25 participants with moderate CI, 60% recalled falls and 58% fell during follow-up (1.2 (±1.8) falls/person), the sensitivity of fall history being 71% and of turning 69%.
Researchers need not exclude people with CI assuming falls are more frequent and less predictable than among those without. Fall rates (falls/person during follow-up) were similar among people with and without CI. Falls and difficulty turning were more sensitive predictors of falling in those with CI than those without: a simple mobility test may suggest an individual's risk of falling if a history is unavailable. Most PwP with moderate CI fall repeatedly: carer involvement facilitates their inclusion in research.
我们比较了有认知障碍（CI）和无认知障碍的帕金森病患者（PwP）的跌倒频率及预测情况；研究人员有时会忽略前者，因为担心同意书、回忆及依从性问题，以及跌倒频率和可预测性方面的差异。
我们从一家诊所招募了101名帕金森病患者，使用蒙特利尔认知评估量表来测量认知障碍，回顾性记录12个月内的反复跌倒情况，并将“反复跌倒”和“转身困难”作为三个月内跌倒的预测因素进行评估。
参与者的年龄中位数为76岁，确诊时间为6年。在40名无认知障碍的参与者中，40%回忆起有跌倒经历，55%在随访期间跌倒（每人1.9（±3.8）次跌倒），跌倒史的敏感性为57%，转身困难的敏感性为36%。在36名轻度认知障碍的参与者中，42%回忆起有跌倒经历，42%在随访期间跌倒（每人1.2（±1.8）次跌倒），跌倒史的敏感性为67%，转身困难的敏感性为69%。在25名中度认知障碍的参与者中，60%回忆起有跌倒经历，58%在随访期间跌倒（每人1.2（±1.8）次跌倒），跌倒史的敏感性为71%，转身困难的敏感性为69%。
研究人员不必因为认知障碍患者的跌倒比无认知障碍者更频繁且更难预测就将其排除在外。有认知障碍和无认知障碍者的跌倒率（随访期间每人跌倒次数）相似。跌倒和转身困难在认知障碍患者中比在无认知障碍者中是更敏感的跌倒预测因素：如果没有跌倒史，一项简单的移动性测试可能提示个体的跌倒风险。大多数中度认知障碍的帕金森病患者会反复跌倒：护理人员的参与有助于他们纳入研究。
