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Three tests combined offer a good way to predict which people with Parkinson's disease are most likely to fall, a study finds. The study included 101 people with Parkinson's disease. Researchers gave them tests related to symptoms, balance and movement. In the next 6 months, nearly half of the people in the study fell. Half of those who fell did so more than once. Most of those who fell had three things in common. They tended to have more severe Parkinson's symptoms. They said they often "froze" while walking. They also did not do well in balance tests. Researchers said these three tests combined would correctly predict a strong risk of falls about 80% of the time. The study was published online by the journal Neurology. HealthDay News wrote about it June 23.

What Is the Doctor's Reaction?

About 1 million people in the United States have Parkinson's disease. Their most common symptoms are shaking, an inability to relax muscles, and "bradykinesia," or very slow movements. These symptoms can be bothersome and disabling. But they are not the biggest day-to-day threat to health and independence. That distinction may belong to something that is not unique to Parkinson's disease: falling.

Falls are common among people with Parkinson's disease. The disease itself may impair movement and balance. And medicines commonly used to treat it may contribute to falls. For example, Carbidopa/Levodopa (Sinemet) may cause dizziness and increase the risk of falling.

Even a minor fall can have a major impact on overall health and ability to function. Parkinson's disease is most common among older adults. So is osteoporosis, a disease that makes bones brittle. Therefore, a "low impact" fall may cause a hip fracture. Older adults who break a hip are more likely to lose their independence and more likely to die.

Other injuries from a fall, such as bleeding around the brain, can also reduce a person's ability to function in everyday life. Falls can even lead to earlier death for someone with Parkinson's disease.

Because falls are a serious threat, researchers took a look at what increases the risk of falls. Results appear this week in the journal Neurology. The study included 101 people with Parkinson's disease. At the study's start, each subject had to be able to walk without a cane or other help. Researchers collected information about Parkinson's symptoms. They performed tests of balance. And they kept track of who fell during the next 6 months.

The researchers found that:

  • Falling was common. Nearly half of the people fell during the 6-month study.

  • About 1 out of 4 people fell more than once.

  • Fall risk was highest among those who had:

    • Worse overall Parkinson's disease symptoms

    • Frequent "freezing" while walking

    • Abnormal results on the test of balance

This study suggests that it may not be hard for doctors to predict fall risk in people with Parkinson's disease. Knowing who's most at risk could lead to prevention efforts. If effective, this could improve people's quality of life. It could even save lives.

What Changes Can I Make Now?

If you have Parkinson's disease, let your doctor know how it affects you. Discuss your risk of falling and how to prevent it.

Discuss ways to prevent other problems that falls can cause. For example, ask about bone mineral density testing. If the test shows that you have osteoporosis, you can take measures to increase bone strength. These include exercise and treatment with calcium, vitamin D and other medicines to build bone.

Working with a physical therapist may help you to strengthen your leg muscles and improve balance. Using a cane or walker can help many people feel more stable when they walk. If you have a high risk of falling, be careful to walk where there is something to grab in case you start to fall.

Effective treatment of Parkinson's disease may reduce the risk of falls. Treatment depends on how severe your symptoms are:

  • For mild symptoms, no treatment may be needed.

  • For symptoms that impair your ability to walk, work, write or care for yourself, medicines can help. They include:

    • Levodopa/carbidopa

    • Entacapone (Comtan)

    • Tolcapone (Tasmar)

    • Bromocriptine (Parlodel)

    • Pramipexole (Mirapex)

    • Ropinirole (Requip)

  • For severe symptoms that don't respond to standard drugs, your doctor may recommend a "brain pacemaker." This device applies a small electric current to tiny wires inserted into precise locations in the brain.

  • If you have Parkinson's disease and symptoms of depression, other treatments may help. They include:

    • Antidepressant medicines

    • Counseling

    • Other efforts to counter depression, such as exercise

You may be eligible for experimental treatment for Parkinson's disease. This could give you access to a promising treatment that is not available any other way. Talk to your doctor about this option.

You also can take other measures to reduce your risk of falling.

  • Review your medicines with your doctor or pharmacist. Many medicines can increase the risk of falling.

  • Get your eyes examined, update your eyeglass prescription.

  • Make your home safer. For instance, clear away clutter, remove loose rugs, and cover slick floors. Any of these hazards can increase your risk of falling.

  • Install rails next to your bathtub and stairs. They can provide you with something to grab if you start to fall.

What Can I Expect Looking to the Future?

You can expect researchers to develop innovative treatments for Parkinson's disease. I hope that doctors will focus on prevention of falls among Parkinson's disease patients with the highest risk. This may help to decrease the number of people with Parkinson's disease who suffer fall-related injuries, loss of independence and early death.

Last Annual Review Date: 2010-06-24T00:00:00-06:00 Copyright: Harvard Health Publications

Reference: Parkinson's Disease section on Better Medicine



Did You Know?

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Parkinson's disease only affects older adults.