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Fall-related measures in elderly individuals and Parkinson's disease subjects.

ABSTRACT: Falls pose a serious problem in elderly and clinical populations. Most often, they lead to a loss of mobility and independence. They might also be an indirect cause of death. The aim of this study was to determine an objective predictor of the fear of falling and falls in elderly subjects (ESs) and Parkinson's disease (PD) subjects. Thirty-two ESs were examined in this study, of whom sixteen were diagnosed with PD. The testing procedures comprised force plate measurements (limit of stability test-LOS test) and clinical tests (Berg Balance Scale, Functional Reach Test, Timed Up and Go test, Tinetti test). The Falls Efficacy Scale International (FES-I) was used to evaluate the fear of falling. The range of the maximum forward lean was normalized to the length from the ankle joint to the head of the first metatarsal bone and was named the functional forward stability indicator (FFSI). The FFSI, derived from the LOS test, allowed us to demonstrate the real deficit in functional stability and individual safety margins. Moreover, the FFSI was highly correlated with the FES-I score and almost all clinical test results in elderly subjects (r>0,6; p<0.05). In PD subjects, the FFSI was poorly correlated with the fear of falling, the BBS score and the FR distance; however, a high correlation with the Tinetii test (r>0,6, p<0.05) was noted. The PD subjects presented a different balance strategy when close to their stability limits, which was also reflected in the lower values of sample entropy (t = (-2.40); p<0.05; d = 0.87). The FFSI might be a good predictor of the fear of falling in the group of elderly people. Additionally, the FFSI allows us to show real balance deficits both in PD subjects and in their healthy peers without the need for a reference group and norms. In conclusion, it is postulated that the popular clinical assessments of postural balance in PD subjects should be accompanied by reliable posturography measurements.

SUBMITTER: Michalska J

PROVIDER: S-EPMC7425912 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Fall-related measures in elderly individuals and Parkinson's disease subjects.

Michalska Justyna J Kamieniarz Anna A Brachman Anna A Marszałek Wojciech W Cholewa Joanna J Juras Grzegorz G Słomka Kajetan J KJ

PloS one 20200813 8

Falls pose a serious problem in elderly and clinical populations. Most often, they lead to a loss of mobility and independence. They might also be an indirect cause of death. The aim of this study was to determine an objective predictor of the fear of falling and falls in elderly subjects (ESs) and Parkinson's disease (PD) subjects. Thirty-two ESs were examined in this study, of whom sixteen were diagnosed with PD. The testing procedures comprised force plate measurements (limit of stability tes ...[more]

PMID: 32790749

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Project description:Introduction Postural instability is a known contributing factor to balance dysfunction and increased fall risk in those with Parkinson's disease (PD). Computerized posturography employing a force platform system provides objective, quantitative assessments of postural control impairments. This study examines balance performance as measured by force platform (FP) tests in persons with PD compared to age-matched healthy adults. Secondarily, we examine if these FP measures provide diagnostic and clinically meaningful information about the underlying balance impairments in the PD population. Methods Participants—42 individuals with PD (Hoehn and Yahr stage = 2.33 ± 0.77) and 55 age-matched healthy adults—were assessed on three standardized balance measures on a computerized force platform system. Between groups, comparisons of FP performance were analyzed using independent t-test. Within the group, comparisons for the PD cohort were analyzed using ANOVA for comparing disease stage and Mann–Whitney U test for PD subtypes. Results The PD cohort demonstrated significantly greater postural instability on the sensory organization test (SOT) measures (P=0.013, CI-95% = 1.286 to 10.37) and slower movement velocity on the limits of stability (LOS) test (P=0.001, CI-95% = 0.597 to 1.595) than the healthy cohort, suggesting that these tests were sensitive to detect sensory integration and voluntary postural control deficits in the PD cohort. Within the PD group, the SOT differentiated between H&Y stages 1–3. The motor control test (MCT) detected changes in reactive postural control mainly in later disease stages. All three FP tests distinguished between PD subtypes, with the Posture Gait Instability subtype demonstrating poorer balance performance than Tremor Dominant subtype. Conclusion These findings suggest FP measures provide clinically meaningful, diagnostic information in the examination of balance impairments in individuals with PD. FP measures may inform clinicians regarding intrinsic balance deficits and guide them in designing targeted balance interventions to reduce fall risk in persons with PD.

Project description:BackgroundEfforts to identify fluid biomarkers of Parkinson's disease (PD) have intensified in the last decade. As the role of inflammation in PD pathophysiology becomes increasingly recognized, investigators aim to define inflammatory signatures to help elucidate underlying mechanisms of disease pathogenesis and aid in identification of patients with inflammatory endophenotypes that could benefit from immunomodulatory interventions. However, discordant results in the literature and a lack of information regarding the stability of inflammatory factors over a 24-h period have hampered progress.MethodsHere, we measured inflammatory proteins in serum and CSF of a small cohort of PD (n?=?12) and age-matched healthy control (HC) subjects (n?=?6) at 11 time points across 24 h to (1) identify potential diurnal variation, (2) reveal differences in PD vs HC, and (3) to correlate with CSF levels of amyloid ? (A?) and ?-synuclein in an effort to generate data-driven hypotheses regarding candidate biomarkers of PD.ResultsDespite significant variability in other factors, a repeated measures two-way analysis of variance by time and disease state for each analyte revealed that serum IFN?, TNF, and neutrophil gelatinase-associated lipocalin (NGAL) were stable across 24 h and different between HC and PD. Regression analysis revealed that C-reactive protein (CRP) was the only factor with a strong linear relationship between CSF and serum. PD and HC subjects showed significantly different relationships between CSF A? proteins and ?-synuclein and specific inflammatory factors, and CSF IFN? and serum IL-8 positively correlated with clinical measures of PD. Finally, linear discriminant analysis revealed that serum TNF and CSF ?-synuclein discriminated between PD and HC with a minimum of 82% sensitivity and 83% specificity.ConclusionsOur findings identify a panel of inflammatory factors in serum and CSF that can be reliably measured, distinguish between PD and HC, and monitor inflammation as disease progresses or in response to interventional therapies. This panel may aid in generating hypotheses and feasible experimental designs towards identifying biomarkers of neurodegenerative disease by focusing on analytes that remain stable regardless of time of sample collection.

Project description:Introduction: Falling is one of the primary concerns for people with Parkinson's Disease and occurs predominately during dynamic movements, such as walking. Several methods have been proposed to quantify dynamic balance and to assess fall risk. However, no consensus has been reached concerning which method is most appropriate for examining walking balance during unperturbed and perturbed conditions, particularly in Parkinson's Disease individuals. Therefore, this systematic review aimed to assess the current literature on quantifying dynamic balance in healthy young, elderly and Parkinson's individuals during unperturbed and perturbed walking. Methods: The PubMed database was searched by title and abstract for publications quantifying dynamic balance during unperturbed and mechanically perturbed walking conditions in elderly adults and PD. Inclusion criteria required publications to be published in English, be available in full-text, and implement a dynamic balance quantification method. Exclusion criteria included clinical dynamic balance measures, non-mechanical perturbations, pathologies other than PD, and dual-tasking conditions. The initial database search yielded 280 articles, however, only 81 articles were included after title, abstract and full-text screening. Methodological quality and data were extracted from publications included in the final synthesis. Results: The dynamic balance articles included 26 Coefficient of Variation of Spatiotemporal Variability, 10 Detrended Fluctuation Analysis, 20 Lyapunov Exponent, 7 Maximum Floquet Multipliers, 17 Extrapolated Center of Mass, 11 Harmonic Ratios, 4 Center of Mass-Center of Pressure Separation, 2 Gait Stability Ratio, 1 Entropy, 3 Spatiotemporal Variables, 2 Center of Gravity and Center of Pressure, and 2 Root Mean Square in the final synthesis. Assessment of methodological quality determined that 58 articles had a low methodological rating, a 22 moderate rating, and 1 having a high rating. Conclusion: Careful consideration must be given when selecting a method to quantify dynamic balance because each method defines balance differently, reflects a unique aspect of neuromuscular stability mechanisms, and is dependent on the walking condition (unperturbed vs. perturbed). Therefore, each method provides distinct information into stability impairment in elderly and PD individuals.

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Fall-related measures in elderly individuals and Parkinson's disease subjects.

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Fall-related measures in elderly individuals and Parkinson's disease subjects.

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