TY  - JOUR
PY  - 2019//
TI  - Cardiovascular autonomic neuropathy and falls in Parkinson disease: a prospective cohort study
JO  - Journal of neurology
A1  - Romagnolo, Alberto
A1  - Zibetti, Maurizio
A1  - Merola, Aristide
A1  - Canova, Daniela
A1  - Sarchioto, Marianna
A1  - Montanaro, Elisa
A1  - Artusi, Carlo Alberto
A1  - Vallelonga, Fabrizio
A1  - Maule, Simona
A1  - Lopiano, Leonardo
SP  - 85
EP  - 91
VL  - 266
IS  - 1
N2  - 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. <br><br>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. <br><br>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. <br><br>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.<p />  <p>Language: en</p>
LA  - en
SN  - 0340-5354
UR  - http://dx.doi.org/10.1007/s00415-018-9104-4
ID  - ref1
ER  -