Chou Kelvin L, Elm Jordan J, Wielinski Catherine L, Simon David K, Aminoff Michael J, Christine Chadwick W, Liang Grace S, Hauser Robert A, Sudarsky Lewis, Umeh Chizoba C, Voss Tiffini, Juncos Jorge, Fang John Y, Boyd James T, Bodis-Wollner Ivan, Mari Zoltan, Morgan John C, Wills Anne-Marie, Lee Stephen L, Parashos Sotirios A
Departments of Neurology and Neurosurgery, University of Michigan, Ann Arbor, MI, United States.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States.
J Neurol Sci. 2017 Jun 15;377:137-143. doi: 10.1016/j.jns.2017.04.011. Epub 2017 Apr 11.
Recognizing the factors associated with falling in Parkinson's disease (PD) would improve identification of at-risk individuals.
To examine frequency of falling and baseline characteristics associated with falling in PD using the National Institute of Neurological Disorders and Stroke (NINDS) Exploratory Trials in PD Long-term Study-1 (NET-PD LS-1) dataset.
The LS-1 database included 1741 early treated PD subjects (median 4year follow-up). Baseline characteristics were tested for a univariate association with post-baseline falling during the trial. Significant variables were included in a multivariable logistic regression model. A separate analysis using a negative binomial model investigated baseline factors on fall rate.
728 subjects (42%) fell during the trial, including at baseline. A baseline history of falls was the factor most associated with post-baseline falling. Men had lower odds of post-baseline falling compared to women, but for men, the probability of a post-baseline fall increased with age such that after age 70, men and women had similar odds of falling. Other baseline factors associated with a post-baseline fall and increased fall rate included the Unified PD Rating Scale (UPDRS) Activities of Daily Living (ADL) score, total functional capacity (TFC), baseline ambulatory capacity score and dopamine agonist monotherapy.
Falls are common in early treated PD. The biggest risk factor for falls in PD remains a history of falling. Measures of functional ability (UPDRS ADL, TFC) and ambulatory capacity are novel clinical risk factors needing further study. A significant age by sex interaction may help to explain why age has been an inconsistent risk factor for falls in PD.
识别与帕金森病（PD）跌倒相关的因素将有助于更好地识别高危个体。
使用美国国立神经疾病和中风研究所（NINDS）帕金森病长期研究-1（NET-PD LS-1）数据集，研究PD患者跌倒的频率以及与跌倒相关的基线特征。
LS-1数据库纳入了1741例早期接受治疗的PD患者（中位随访时间为4年）。对基线特征进行单变量分析，以检验其与试验期间基线后跌倒的相关性。将有统计学意义的变量纳入多变量逻辑回归模型。使用负二项模型进行单独分析，以研究跌倒率的基线因素。
728例患者（42%）在试验期间跌倒，包括在基线时跌倒。跌倒的基线病史是与基线后跌倒最相关的因素。与女性相比，男性基线后跌倒的几率较低，但对于男性，基线后跌倒的概率随年龄增加而增加，以至于70岁以后，男性和女性跌倒的几率相似。与基线后跌倒和跌倒率增加相关的其他基线因素包括统一帕金森病评定量表（UPDRS）日常生活活动（ADL）评分、总功能能力（TFC）、基线步行能力评分和多巴胺激动剂单药治疗。
跌倒在早期接受治疗的PD患者中很常见。PD患者跌倒的最大风险因素仍然是跌倒病史。功能能力（UPDRS ADL、TFC）和步行能力的测量是需要进一步研究的新的临床风险因素。显著的年龄与性别交互作用可能有助于解释为什么年龄一直是PD患者跌倒的一个不一致的风险因素。
