Neuroscience Research Australia, University of New South Wales, New South Wales, Australia; School of Public Health and Community and Medicine, University of New South Wales, New South Wales, Australia.
Population Heath Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, United Kingdom.
Braz J Phys Ther. 2021 Jul-Aug;25(4):437-443. doi: 10.1016/j.bjpt.2020.11.005. Epub 2020 Dec 6.
Executive dysfunction and risk of falling are hallmarks of Parkinson's disease (PD). However, it is unclear how executive dysfunction predisposes people with PD to falling.
To: (i) identify sensorimotor, balance, and cardiovascular risk factors for falls that discriminate between those with normal executive function and those with mild and marked executive dysfunction in people with PD and (ii) determine whether mild and marked executive dysfunction are significant risk factors for falls when adjusting for PD duration and severity and freezing of gait (FOG).
Using the Frontal Assessment Battery, 243 participants were classified into normal executive function (n = 87), mild executive dysfunction (n = 100), and marked executive dysfunction (n = 56) groups. Participants were asked if they had episodes of FOG in the last month and were assessed with the Movement Disorders Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS), the Hoehn and Yahr Scale, the physiological profile assessment, and tests of orthostatic hypotension, coordinated stability, and gait and were then followed-up prospectively for falls for 32-52 weeks.
Several PD-specific (elevated Hoehn and Yahr stage, higher MDS-UPDRS scale scores, a history of FOG, Postural Instability and Gait Difficulty subtype, and longer PD duration), sensorimotor (poor vision, knee extension weakness, slow simple reaction time), and balance (greater postural sway and poor controlled leaning balance) factors discriminated among the normal executive function and mild and marked executive dysfunction groups. Fall rates (mean ± SD) differed significantly among the groups (normal executive function: 1.0 ± 1.7; mild executive dysfunction: 2.8 ± 5.2; marked executive dysfunction: 4.7 ± 7.3) with the presence of both mild and marked executive dysfunction identified as significant risk factors for falls when adjusting for three measures of PD severity (Hoehn and Yahr scale scores, disease duration, and FOG).
Several PD-specific, sensorimotor, and balance factors differed significantly among the normal, mild, and marked executive dysfunction groups and both mild and marked executive dysfunction were identified as independent risk factors for falls in people with PD.
执行功能障碍和跌倒风险是帕金森病（PD）的特征。然而，执行功能障碍如何使 PD 患者更容易跌倒尚不清楚。
（i）确定可区分 PD 患者中具有正常执行功能、轻度和明显执行功能障碍的人跌倒的感觉运动、平衡和心血管危险因素，以及（ii）确定在调整 PD 持续时间和严重程度以及冻结步态（FOG）后，轻度和明显的执行功能障碍是否是跌倒的重要危险因素。
使用额叶评估电池，将 243 名参与者分为正常执行功能（n=87）、轻度执行功能障碍（n=100）和明显执行功能障碍（n=56）组。询问参与者在过去一个月是否有 FOG 发作，并使用运动障碍协会-统一帕金森病评定量表（MDS-UPDRS）、Hoehn 和 Yahr 量表、生理概况评估和体位性低血压、协调稳定性以及步态测试进行评估，然后前瞻性随访 32-52 周以记录跌倒情况。
几个与 PD 相关的因素（较高的 Hoehn 和 Yahr 分期、较高的 MDS-UPDRS 评分、FOG 病史、姿势不稳定和步态困难亚型、PD 持续时间较长）、感觉运动（视力差、膝关节伸展无力、简单反应时间较慢）和平衡（更大的姿势摆动和较差的控制倾斜平衡）因素在正常执行功能和轻度和明显执行功能障碍组之间有明显区分。各组的跌倒率（平均值±标准差）差异显著（正常执行功能：1.0±1.7；轻度执行功能障碍：2.8±5.2；明显执行功能障碍：4.7±7.3），调整三种 PD 严重程度测量值（Hoehn 和 Yahr 量表评分、疾病持续时间和 FOG）后，轻度和明显执行功能障碍均被确定为跌倒的独立危险因素。
正常、轻度和明显执行功能障碍组之间存在几个与 PD 相关、感觉运动和平衡的显著差异，轻度和明显执行功能障碍均被确定为 PD 患者跌倒的独立危险因素。
