Predicting falls in Parkinson disease

Instrumented Test of Sensory Integration for Balance: A Validation Study

BACKGROUND AND PURPOSE

Abnormal postural sway is associated with an increase in risk of falls but is difficult for clinicians to accurately quantify without access to laboratory equipment. Instrumenting clinical outcome measures using body-worn movement monitors is a low-cost alternative. This is the first study to compare the modified Clinical Test of Sensory Integration for Balance (i-mCTSIB) to the laboratory test of the Sensory Organization Test (SOT) with dynamic posturography in a group of participants with Parkinson's disease (PD) and subtle balance limitations. The purpose of this study was to (1) determine the concurrent validity of the i-mCTSIB with the SOT (6 and 4 conditions) and (2) compare the i-mCTSIB and the SOT to differentiate between individuals with and without recent falls within the previous 6 months.

METHODS

This cross-sectional study examined 26 participants with idiopathic PD who had a Motor Unified Parkinson's Disease Rating Scale score of 32.7 (13.5) out of 108.

RESULTS

The composite and conditions 1 and 4 of the i-mCTSIB and SOT scores were significantly correlated: composite scores r = -0.64 (P ≤ .001), C1 r = -0.43 (P = .03), C3 r = -0.60 (P ≤ .01), and C4 r = -0.54 (P ≤ .001). A significant difference was observed in mean i-mCTSIB composite scores between fallers and nonfallers (P = .04). In contrast, the SOT composite was not significantly different between fallers and nonfallers (P = 0.31).

DISCUSSION

The results suggest that the i-mCTSIB may be a valid and clinically meaningful measure of sensory organization in persons with PD, even those with mild postural instability as measured by the median Hoehn and Yahr score (2.0). Future research should evaluate predictive validity of the i-mCTSIB for prospective falls.

CONCLUSION

The instrumented mCTSIB with portable, body-worn movement allows clinicians to quantify abnormal postural sway without the ceiling effects of clinical balance testing or the expense and importability of force plate technology in the SOT. Instrumenting mCTSIB may also distinguish between fallers and nonfallers.

Parkinson Disease-Mediated Gastrointestinal Disorders and Rational for Combinatorial Therapies

A gradual loss of dopamine-producing nerve cells gives rise to a common neurodegenerative Parkinson’s disease (PD). This disease causes a neurotransmitter imbalance in the brain and initiates a cascade of complications in the rest of the body that appears as distressing symptoms which include gait problems, tremor, gastrointestinal (GI) disorders and cognitive decline. To aid dopamine deficiency, treatment in PD patients includes oral medications, in addition to other methods such as deep brain stimulation and surgical lesioning. Scientists are extensively studying molecular and signaling mechanisms, particularly those involving phenotypic transcription factors and their co-regulatory proteins that are associated with neuronal stem cell (SC) fate determination, maintenance and disease state, and their role in the pathogenesis of PD. Advancement in scientific research and “personalized medicine” to augment current therapeutic intervention and minimize the side effects of chemotherapy may lead to the development of more effective therapeutic strategies in the near future. This review focuses on PD and associated GI complications and summarizes the current therapeutic modalities that include stem cell studies and combinatorial drug treatment.

Recent advances in the assessment and treatment of falls in Parkinson's disease

Falls are among the most incapacitating features of Parkinson's disease. Prevention of falls requires a systematic assessment of all contributing factors (with emphasis on freezing of gait and frontal executive dysfunction), and a multidisciplinary treatment approach tailored to the specific pathophysiology of falls for each individual patient.