title: Natural history of falls in a population-based cohort of patients with Parkinson's disease: an 8-year prospective study.
abstract: BACKGROUND
  Prospective long-term studies of falls in Parkinson's disease (PD) are scarce.
  
  
  OBJECTIVE
  To examine the development of falls over 8 years in a population-based cohort of ambulatory patients with PD, and to investigate predictors of future falls in non-fallers at baseline.
  
  
  METHODS
  All patients were examined at baseline and after 4 and 8 years, including the UPDRS, MMSE, Montgomery and Aaberg Depression Rating Scale, Functional Comorbidity Index, and a clinical dementia interview. Logistic regression models were applied to investigate baseline risk factors for future falls. A total of 211 patients were included at baseline, whereas 121 and 64 were re-examined at 4 and 8 years, respectively.
  
  
  RESULTS
  The prevalence of falls increased from 41% (87 of 211) at baseline to 72% (46 of 64) after 8 years of prospective follow-up (disease duration 16.2 ± 4.8 years). Forty-seven non-falling patients at baseline completed all study visits, of these 68% (n = 32) changed fall status during follow-up. Predictive variables for current falling after 4 years were rare or occasional freezing of gait (OR 6.6, 95% CI 1.2-36.9), higher levodopa equivalent doses and more severe speech and axial impairment (both OR 1.3, 95% CI 1.0-1.7) in non-fallers at baseline. Higher baseline age was the only risk factor for current falling after 8 years.
  
  
  CONCLUSIONS
  Nearly ¾ of the PD cohort reported falling after 8 years of follow-up. Disease-specific gait and axial impairments were the major risk factors for future falls in non-fallers at baseline. This has implications for patient education and management.
authors.affiliation: The Norwegian Centre for Movement Disorders, Stavanger University Hospital, PO Box 8100, N-4068 Stavanger, Norway. Electronic address: ylva.hivand.hiorth@sus.no.
authors.forename: Ylva Hivand
authors.initials: YH
authors.lastname: Hiorth
authors.affiliation: The Norwegian Centre for Movement Disorders, Stavanger University Hospital, PO Box 8100, N-4068 Stavanger, Norway.
authors.forename: Jan Petter
authors.initials: JP
authors.lastname: Larsen
authors.affiliation: The Norwegian Centre for Movement Disorders, Stavanger University Hospital, PO Box 8100, N-4068 Stavanger, Norway.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Lode
authors.affiliation: The Norwegian Centre for Movement Disorders, Stavanger University Hospital, PO Box 8100, N-4068 Stavanger, Norway; Department of Neurology, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Kenn Freddy
authors.initials: KF
authors.lastname: Pedersen
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D015331:Cohort Studies; D018672:Community Health Planning; D004185:Disability Evaluation; D005260:Female; D020233:Gait Disorders, Neurologic / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D010300:Parkinson Disease / Q000150:complications / Q000453:epidemiology*; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Axial impairment; Falls; Freezing; Parkinson's disease; Prospective study