Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Neuroscience Center, Samsung Medical Center, Seoul, Korea.
Sci Rep. 2017 Jun 20;7(1):3921. doi: 10.1038/s41598-017-04302-7.
Falls are a common and disabling symptom in patients with Parkinson's disease (PD). For prevention, it is important to understand the pathophysiology of falls in PD patients, but the predictors for the possible mechanisms underlying such falls have not been clearly elucidated. In this prospective observational study, we investigated the implications of falling direction to predict the mechanisms of recurrent falls in PD patients. We enrolled 62 recurrent fallers with PD and divided them into two groups according to the main falling directions: 45 PD fallers who fell forward (forward fallers), and 17 PD fallers who fell in the other directions (non-forward fallers). Although there was no difference in demographic data, parkinsonism, or frontal lobe function, forward fallers showed more severe falls and tended to fall during walking or turning, while non-forward fallers usually fell during sitting/standing or turning. Additionally, forward fallers revealed higher score on a freezing of gait (FOG) questionnaire. Logistic regression analysis demonstrated that FOG was associated with falling forward, while balance impairment, akinetic-rigid subtype, and neuropsychiatric symptoms were associated with falling into the other directions. Our results indicate that FOG and balance impairment are two major mechanisms for recurrent falling in PD patients, and falling direction is an important predictor for these mechanisms.
跌倒在帕金森病（PD）患者中很常见，且会导致残疾。为了预防跌倒，了解 PD 患者跌倒的病理生理学非常重要，但导致这些跌倒的可能机制的预测因素尚未明确。在这项前瞻性观察研究中，我们研究了跌倒方向对预测 PD 患者复发性跌倒机制的影响。我们招募了 62 名复发性跌倒的 PD 患者，并根据主要跌倒方向将他们分为两组：45 名向前跌倒的 PD 跌倒者（向前跌倒组）和 17 名向其他方向跌倒的 PD 跌倒者（非向前跌倒组）。尽管两组患者在人口统计学数据、帕金森病或额叶功能方面没有差异，但向前跌倒组的跌倒更严重，且更倾向于在行走或转弯时跌倒，而非向前跌倒组通常在坐站或转弯时跌倒。此外，向前跌倒组在冻结步态（FOG）问卷上的得分更高。逻辑回归分析表明，FOG 与向前跌倒有关，而平衡障碍、运动不能-强直型和神经精神症状与向其他方向跌倒有关。我们的研究结果表明，FOG 和平衡障碍是 PD 患者复发性跌倒的两个主要机制，而跌倒方向是这些机制的重要预测因素。
