title: Trait impulsivity is associated with the risk of falls in Parkinson's disease.
abstract: OBJECTIVE
  Impulsivity is a "tendency to act prematurely without foresight." Clinical experience suggests that such impulsive behavior can impact on the fall risk in Parkinson's disease (PD), but this has never been tested. We investigated whether trait impulsivity is related to fall risk in a large cohort of PD patients. We also investigated whether trait impulsivity affects the fall risk differently for patients with more or less postural instability and gait disability (PIGD).
  
  
  METHODS
  388 patients with PD (H&Y ≤ 3) completed the Barratt Impulsiveness Scale (BIS-11, higher scores indicating greater impulsivity) to assess trait impulsivity, including three subscales: motor impulsivity (e.g. "I do things without thinking"), attentional impulsivity (e.g. "I concentrate easily") and non-planning (e.g. "I plan tasks carefully"). Falls were registered prospectively for 6 months. Patients classified as non-fallers (0 falls, n = 237) were compared to recurrent PD fallers (>1 fall, n = 78).
  
  
  RESULTS
  Total impulsivity scores were higher for recurrent fallers (59.5) compared to non-fallers (56.8; p = .012). This effect was predominantly driven by higher scores on the subscale for attentional impulsivity (p = .003). The difference in attentional impulsivity was independent of gender, disease severity, dopaminergic medication, and cognitive function. Motor and non-planning impulsivity did not differ between recurrent fallers and non-fallers. There was no evidence that impulsivity modulated the association between PIGD and fall risk.
  
  
  CONCLUSIONS
  This is the first evidence that impulsivity, in particular in the attentional domain, is related to fall risk in PD.
authors.affiliation: Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Institute for Studies in Sports and Exercise, HAN University of Applied Sciences, Nijmegen, The Netherlands.
authors.forename: Katrijn
authors.initials: K
authors.lastname: Smulders
authors.affiliation: Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Rianne A
authors.initials: RA
authors.lastname: Esselink
authors.affiliation: Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands.
authors.forename: Roshan
authors.initials: R
authors.lastname: Cools
authors.affiliation: Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Bastiaan R
authors.initials: BR
authors.lastname: Bloem
mesh_terms: D000058:Accidental Falls; D000368:Aged; D003071:Cognition; D003710:Demography; D004298:Dopamine / Q000378:metabolism; D005260:Female; D020233:Gait Disorders, Neurologic; D006801:Humans; D007175:Impulsive Behavior; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010300:Parkinson Disease / Q000503:physiopathology*; D011187:Posture; D012044:Regression Analysis; D057566:Self Report
chemical_list: D004298:Dopamine