Anxiety Independently Contributes to Severity of Freezing of Gait in People With Parkinson's Disease.

Freezing of gait is a disabling feature of Parkinson's disease, and it has been shown that nonmotor symptoms, such as anxiety and cognitive impairment, may be involved in the pathophysiology of the phenomenon. However, the association between freezing of gait severity and nonmotor symptoms is yet to be determined. Therefore, the overall aim of this study was to determine factors that contribute to severity of freezing of gait in people with Parkinson's disease. Participants (N=78) were assessed by disease-specific and self-report measures, including the Hospital Anxiety and Depression Scale (HADS), the Montreal Cognitive Assessment, and the Freezing of Gait Questionnaire (FOG-Q). Participants were classified as "freezers" if they scored ≥1 on item 3 of the FOG-Q; the sum of items 3-6 was used to determine freezing of gait severity. Freezers (N=27) showed higher scores on the HADS anxiety (p=0.002) and HADS depression (p=0.006) subscales. A multivariate linear model showed that disease severity (as measured by using the modified Hoehn and Yahr scale) accounted for 31% of the variance in FOG-Q severity scores (p<0.001). The presence of HADS anxiety ≥8 points increased the explained variance to 38% (p=0.010), and the full model (reached by adding the levodopa equivalent dose) explained 42% of the variance in freezing of gait severity (p=0.026). The findings provide additional support for the contribution of anxiety to greater freezing of gait severity, taking into account not only the frequency but the duration of the episodes, and suggest that anxiety should be routinely evaluated in people with Parkinson's disease who present with freezing of gait.

Predictors of Recurrent Falls in People with Parkinson's Disease and Proposal for a Predictive Tool.

BACKGROUND: Falls are a debilitating problem for people with Parkinson's disease (PD). OBJECTIVES: To compare clinical and functional characteristics of non-fallers, single and recurrent fallers (≥2 falls); to determine predictors of time to second fall; and to develop a predictive tool for identifying people with PD at different categories of falls risk. METHODS: Participants (n = 229) were assessed by disease-specific, self-report and balance measures and followed up for 12 months. Area under the receiver operating characteristic curves (AUC), Kaplan-Meier curves and log-rank test were performed. Selected predictors with p < 0.10 in univariate analysis were chosen to be entered into the Cox regression model. RESULTS: Eighty-four (37%) participants had ≥2 falls during the follow-up. Recurrent fallers significantly differed from single fallers. The final Cox model included history of ≥2 falls in the past year (Hazard Ratio [HR] = 3.94; 95% confidence interval [CI] 2.26-6.86), motor fluctuations (HR = 1.91; 95% CI 1.12-3.26), UPDRS activities of daily living (ADL) (HR = 1.10 per 1 point increase; 95% CI 1.06-1.14) and levodopa equivalent dose (LED) (HR = 1.09 per 100 mg increase; 95% CI 1.02-1.16). A 3-predictor tool included history of ≥2 falls in the past year, motor fluctuations and UPDRS ADL >12 points (AUC = 0.84; 95% CI 0.78-0.90). By adding LED >700 mg/day and Berg balance scale ≤49 points, a 5-predictor tool was developed (AUC = 0.86; 95% CI 0.81-0.92). CONCLUSIONS: Two predictive tools with moderate-to-high accuracy may identify people with PD at low, medium and high risk of falling recurrently within the next year. However, future studies to address external validation are required.

Comparison of Self-report and Performance-Based Balance Measures for Predicting Recurrent Falls in People With Parkinson Disease: Cohort Study.

BACKGROUND: Balance confidence and fear of falling are factors associated with recurrent falls in people with Parkinson disease (PD). However, the accuracy for predicting falls on the basis of self-report measures has not been widely investigated. OBJECTIVE: The study objectives were: (1) to compare the accuracy of the Activities-specific Balance Confidence Scale (ABC) and the Falls Efficacy Scale-International (FES-I) with that of the Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Functional Reach Test (FRT), and Timed "Up & Go" Test (TUG) for predicting recurrent falls in people with PD and (2) to explore the ability of combinations of up to 3 tests to predict recurrent falls. DESIGN: This was a prospective cohort study involving 225 people with PD. METHODS: Participants were assessed with the ABC, FES-I, BBS, FRT, TUG, and DGI. Participants who reported 2 or more falls in the 12-month follow-up period were classified as recurrent fallers. Areas under the receiver operating characteristic curves were determined, and the Akaike information criterion was used to select the best predictive model. RESULTS: Eighty-four participants (37.3%) were classified as recurrent fallers. Areas under the receiver operating characteristic curves for the ABC, FES-I, TUG, FRT, DGI, and BBS were 0.73, 0.74, 0.72, 0.74, 0.76, and 0.79, respectively. Two-test models provided additional discriminating ability compared with individual measures and had Akaike information criterion values similar to those of 3-test models, particularly the combination of the BBS with the FES-I. LIMITATIONS: The lack of an external validation sample was a limitation of this study. CONCLUSIONS: The ABC and FES-I demonstrated moderate accuracy in predicting recurrent falls and a predictive ability similar to that of performance-based balance measures, especially the FRT and the TUG. Two-test models showed performance similar to that of 3-test models, suggesting that a combination of 2 measures may improve the ability to predict recurrent falls in people with PD. Specifically, the combination of the BBS with the FES-I may be considered.

Recurrent Falls in People with Parkinson's Disease without Cognitive Impairment: Focusing on Modifiable Risk Factors.

Falls can be considered a disabling feature in Parkinson's disease. We aimed to identify risk factors for falling, testing simultaneously the ability of disease-specific and balance-related measures. We evaluated 171 patients, collecting demographic and clinical data, including standardized assessments with the Unified Parkinson's Disease Rating Scale (UPDRS), activities of daily living (ADL) and motor sections, modified Hoehn and Yahr Scale, Schwab and England, eight-item Parkinson's Disease Questionnaire, Activities-specific Balance Confidence Scale, Falls Efficacy Scale-International (FES-I), Berg Balance Scale, Dynamic Gait Index, Functional Reach, and Timed Up and Go. ROC curves were constructed to determine the cutoff scores for all measures. Variables with P < 0.1 entered a logistic regression model. The prevalence of recurrent falls was 30% (95% CI 24%-38%). In multivariate analysis, independent risk factors for recurrent falls were (P < 0.05) levodopa equivalent dose (OR = 1.283 per 100 mg increase; 95% CI = 1.092-1.507), UPDRS-ADL > 16 points (OR = 10.0; 95% CI = 3.6-28.3), FES-I > 30 points (OR = 6.0; 95% CI = 1.6-22.6), and Berg ≤ 48 points (OR = 3.9; 95% CI = 1.2-12.7).We encourage the utilization of these modifiable risk factors in the screening of fall risk.

Differential aspects of stroke and congestive heart failure in quality of life reduction: a case series with three comparison groups.

BACKGROUND: To assess QOL of patients with stroke in comparison to other groups (caregivers and CHF patients), to identify which items of QOL are more affected on each group and what is the functional profile of patients with stroke. METHODS: Consecutive stroke or congestive heart failure (CHF) patients were evaluated and compared to their caregivers (caregivers). The NIH Stroke Scale (NIHSS) and EuroQoL-5D (EQ-5D) scale were applied. RESULTS: We evaluated 67 patients with stroke, 62 with CHF and 67 caregivers. For stroke patients, median NIHSS score was four. EQ-5D score was significantly worse in stroke, as compared to CHF and caregivers (0.52, 0.69 and 0.65, respectively). Mobility and usual activity domains were significantly affected in stroke and CHF patients as compared to caregivers; and self-care was more affected in stroke as compared with the other two groups. CONCLUSIONS: Despite a mild neurological deficit, there was a significantly worse QOL perception in stroke as compared to CHF patients, mostly in their perception of self-care.

Validation of the EuroQol quality of life questionnaire on stroke victims.

OBJECTIVE: To validate a quality of life scale, EuroQoL, on stroke patients. METHOD: 67 patients were scored simultaneously for EuroQoL-5 Dimensions (EQ-5D), NIH Stroke Scale (NIHSS) and modified Barthel Index (mBI). Pearson test was used to correlate each scale. Additionally, 31 patients were examined by two independent evaluators on the same day through application of EQ-5D. Kappa statistics were used to evaluate interobserver agreement. RESULTS: EQ-5D showed good correlation with both stroke severity (NIHSS, r= -0.404, P<0.001) and degree of impairment on activities of daily living (mBI, r=0.512, P<0.001). We noticed a good interobserver agreement (k>0.60) in all dimensions evaluated (P<0.01). CONCLUSION: We demonstrated that EQ-5D is reproducible and valid on evaluation of quality of life in patients post stroke in Brazil.