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31.10.2018 | Original Communication

Cardiovascular autonomic neuropathy and falls in Parkinson disease: a prospective cohort study

verfasst von: Alberto Romagnolo, Maurizio Zibetti, Aristide Merola, Daniela Canova, Marianna Sarchioto, Elisa Montanaro, Carlo Alberto Artusi, Fabrizio Vallelonga, Simona Maule, Leonardo Lopiano

Erschienen in: Journal of Neurology | Ausgabe 1/2019

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Abstract

Background

Falls represent one of the main complications of Parkinson’s disease (PD), significantly lowering quality of life. Cardiovascular autonomic neuropathy (cAN) is one of the key contributing factors to PD-associated falls. However, a direct quantification of its impact on the risk of falling in PD is still lacking. In this 12-month prospective study, we sought to evaluate the association between cAN and falls.

Methods

Fifty consecutive patients were evaluated with a standardized battery of autonomic testing, Unified Parkinson’s Disease Rating Scale, push and release (P&R) test, timed up and go test, freezing of gait (FOG) questionnaire, Montreal cognitive assessment (MoCA). Dyskinesia severity and presence of REM sleep behavioral disorder (RBD) were additionally considered. Patients were followed-up for 12 months.

Results

We observed a 38% prevalence of cAN. At baseline, 36% of patients reported at least one fall in the previous 6 months. This figure increased to 56% over the follow-up. After adjusting for age, disease duration, axial symptoms, MoCA and dopaminergic treatment, cAN was significantly associated with a 15-fold (OR 15.194) higher probability of falls; orthostatic hypotension (OH), the most common expression of cAN, with a 10-fold probability (OR 10.702). In addition P&R test (OR 14.021), RBD (OR 5.470) and FOG (OR 1.450) were independently associated with greater probability of falls.

Conclusions

cAN, including but not limited to OH, is a strong independent predictor of falls in PD. Future research endeavors clarifying to what extent pharmacological and non-pharmacological treatments targeting autonomic dysfunctions might reduce the risk of falls are warranted.

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Titel: Cardiovascular autonomic neuropathy and falls in Parkinson disease: a prospective cohort study
verfasst von: Alberto Romagnolo
Maurizio Zibetti
Aristide Merola
Daniela Canova
Marianna Sarchioto
Elisa Montanaro
Carlo Alberto Artusi
Fabrizio Vallelonga
Simona Maule
Leonardo Lopiano
Publikationsdatum: 31.10.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Journal of Neurology / Ausgabe 1/2019
Print ISSN: 0340-5354
Elektronische ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-018-9104-4

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Cardiovascular autonomic neuropathy and falls in Parkinson disease: a prospective cohort study