title: Understanding falls in progressive supranuclear palsy.
abstract: Progressive supranuclear palsy (PSP) is characterized by frequent falls which worsen with disease progression, causing substantial morbidity and mortality. Few studies have investigated which factors contribute to falls in PSP, and all have involved few participants, thus lacking necessary statistical power. The aim of this study was to identify clinical parameters most significantly associated with increasing falls in PSP, using the largest sample of patients to date.
  
  
  
  Comprehensive clinical data were collected from 339 not demented PSP patients meeting the NINDS-SPSP criteria, who were divided into two groups - Infrequent Fallers (IF; n = 118) with rare falls, and Frequent Fallers (FF; n = 221) who fell occasionally to multiple times a day. Of 198 clinical parameters, we hypothesized 38 to be correlated with an increasing risk of falls. These 38 parameters were analyzed via univariate regression analysis to determine the strength of their association with fall frequency. Unit odds ratios identified the magnitude with which each parameter resulted in an increasing risk of falls.
  
  
  
  Twenty-five of 38 parameters analyzed were significantly associated with fall frequency based on univariate analysis. Symptom duration, clinical measures of disease severity, and several motoric and oculomotor clinical parameters were associated with FF. Examined cognitive parameters and slowing of vertical saccades were not.
  
  
  
  The clinical parameters identified as associated with increased frequency of falls improve our understanding of why they occur and may help identify not demented PSP patients at risk for increasing falls.
authors.affiliation: Cleveland Clinic Lou Ruvo Center for Brain Health, USA; University of California San Diego, Department of Neurosciences, USA.
authors.forename: Brent
authors.initials: B
authors.lastname: Bluett
authors.affiliation: University of California San Diego, Department of Neurosciences, USA. Electronic address: ilitvan@ucsd.edu.
authors.forename: Irene
authors.initials: I
authors.lastname: Litvan
authors.affiliation: Anatechs, LLC, USA.
authors.forename: Shumin
authors.initials: S
authors.lastname: Cheng
authors.affiliation: Emory University, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Juncos
authors.affiliation: Case Western Reserve University, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Riley
authors.affiliation: University of Alabama at Birmingham, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Standaert
authors.affiliation: University of Maryland, USA.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Reich
authors.affiliation: Rush University, USA; University of Colorado, USA.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Hall
authors.affiliation: University of Colorado, USA.
authors.forename: Benzi
authors.initials: B
authors.lastname: Kluger
authors.affiliation: University of Utah, USA; Banner Sun Health Research Institute, USA.
authors.forename: David
authors.initials: D
authors.lastname: Shprecher
authors.affiliation: Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research, Toronto Western Hospital, Canada.
authors.forename: Connie
authors.initials: C
authors.lastname: Marras
authors.affiliation: Baylor College of Medicine, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Jankovic
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D032882:Comprehension; D003430:Cross-Sectional Studies; D005133:Eye Movements / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013494:Supranuclear Palsy, Progressive / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology
keywords: Balance; ENGENE; Falls; Parkinsonism; Postural instability; Progressive supranuclear palsy; Understanding