Prevention of Falls in Parkinson's Disease: Guidelines and Gaps

Movement Disorders Clinical Practice, Journal Year: 2023, Volume and Issue: 10(10), P. 1459 - 1469

Published: Aug. 16, 2023

ABSTRACT Background People living with Parkinson's disease (PD) have a high risk for falls. Objective To examine gaps in falls prevention targeting people PD as part of the Task Force on Global Guidelines Falls Older Adults. Methods A Delphi consensus process was used to identify specific recommendations PD. The current narrative review conducted educational background view identifying fall prevention. Results recent Cochrane recommended exercises and structured physical activities PD; however, types recommend subgroups likely benefit require further consideration. Freezing gait, reduced gait speed, prior history are factors should be incorporated assessments target interventions. Multimodal multi‐domain interventions may beneficial. With advanced or complex PD, balance strength training administered under supervision. Medications, particularly cholinesterase inhibitors, show promise Identifying how engage their families, health professionals education implementation remains challenge. Barriers occur at individual, environmental, policy, system levels. Conclusion Effective mitigation requires strategies reduce this debilitating common problem While exercise is recommended, modalities combine them different (cognitive impairment, freezing, disease) need study.

Language: Английский

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Management of freezing of gait — mechanism-based practical recommendations

Nature Reviews Neurology, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Language: Английский

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Long-term effects of bilateral subthalamic nucleus deep brain stimulation on gait disorders in Parkinson’s disease: a clinical-instrumental study

Journal of Neurology, Journal Year: 2023, Volume and Issue: 270(9), P. 4342 - 4353

Published: May 20, 2023

Language: Английский

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Machine Learning and Wearable Sensors for the Early Detection of Balance Disorders in Parkinson’s Disease

Sensors, Journal Year: 2022, Volume and Issue: 22(24), P. 9903 - 9903

Published: Dec. 16, 2022

Dynamic posturography combined with wearable sensors has high sensitivity in recognizing subclinical balance abnormalities patients Parkinson's disease (PD). However, this approach is burdened by a analytical load for motion analysis, potentially limiting routine application clinical practice. In study, we used machine learning to distinguish PD from controls, as well under and not dopaminergic therapy (i.e., ON OFF states), based on kinematic measures recorded during dynamic through portable sensors. We compared 52 different classifiers derived Decision Tree, K-Nearest Neighbor, Support Vector Machine Artificial Neural Network kernel functions automatically analyze reactive postural responses yaw perturbations IMUs 20 15 healthy subjects. To identify the most efficient algorithm, applied three threshold-based selection criteria accuracy, recall precision) one evaluation criterion goodness index). Twenty-one out of passed threshold 80%. Among these, only nine were considered "optimum" distinguishing subjects according index ≤ 0.25. The Fine Neighbor was best-performing algorithm automatic classification subjects, irrespective therapeutic condition. By contrast, none comparison states. Overall, suitable solution early identification disorders analysis data posturography.

Language: Английский

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Detailed investigation of the levodopa response rates in distinct motor subscores in Parkinson’s disease patients with and without STN-DBS

Neurodegenerative Disease Management, Journal Year: 2025, Volume and Issue: unknown, P. 1 - 9

Published: Feb. 24, 2025

To investigate the levodopa response (LDR) in a detailed manner Parkinson's disease (PD) patients with and without STN-DBS. In this respect, we sought to evaluate effect of LDR on distinct motor symptoms one by one. The data all consecutive PD who visited our movement disorders outpatient clinics at Etlik City Hospital between January 2023 2024 were retrospectively evaluated. We enrolled whose full clinical assessments available. was evaluated according previously described method. included 194 study [49 STN-DBS (+) patients, 145 (-) patients]. duration greater group, as expected (12 y, 5 p = 0.00). ratios for total score subitem scores MDS-UPDRS-3 similar patient groups. All subscores significantly lower 'ON' medication state than 'OFF' both demonstrated rates subitems manner. Our findings demonstrate benefit dopaminergic treatment

Language: Английский

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Nonmotor Symptom Changes and Their Association With Falls Among Parkinson's Disease Patients Undergoing Deep Brain Stimulation: A 1‐Year Cohort Study

CNS Neuroscience & Therapeutics, Journal Year: 2025, Volume and Issue: 31(3)

Published: Feb. 28, 2025

ABSTRACT Objectives Fall severely affects the quality of life Parkinson's disease (PD) patients. Subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective treatment for PD motor symptoms (MS), but DBS increased risk falls in some studies and has mixed effects on nonmotor (NMS). However, link between NMS falls, how influences this relationship, remain unclear. This study investigated changes before after STN‐DBS, longitudinal association falls. Methods The included 136 patients undergoing STN‐DBS April 2020 February 2022. Data were collected preoperatively, at 6 months, 12 months postoperatively. Assessments MS via Unified Disease Rating Scale‐III (UPDRS‐III) Nonmotor Symptoms Scale (NMSS). We used Friedman chi‐square tests to assess Specific circumstances assessed through structured interviews. Generalized estimating equations (GEE) explore associations fall occurrence, as well interaction occurrence. Results Significant improvements ( p < 0.01) observed all NMSS domains except gastrointestinal, with no change there significant both locations where occurred whether freezing gait was present among falling 0.01). GEE analysis revealed mood/cognition = 0.044), gastrointestinal 0.027), urinary 0.007), interactions these 0.05). Conclusions NMS, particularly mood/cognition, symptoms, their MS, are associated underscoring need targeted prevention strategies.

Language: Английский

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Abnormal arm swing movements in Parkinson’s disease: onset, progression and response to L-Dopa

Journal of NeuroEngineering and Rehabilitation, Journal Year: 2025, Volume and Issue: 22(1)

Published: March 4, 2025

Reduced arm swing movements during gait are an early motor manifestation of Parkinson's disease (PD). The clinical evolution, response to L-Dopa and pathophysiological underpinning abnormal in PD remain largely unclear. By using a network wearable sensors, this study objectively assesses patients across different stages therapeutic conditions. Twenty healthy subjects (HS) 40 patients, including 20 early-stage mid-advanced subjects, underwent 6-m Timed Up Go test while monitored through inertial sensors. Arm were evaluated both hemibodies upper limb joints (shoulder elbow), specific time-domain (range motion velocity) frequency-domain measures (harmonics total harmonic distortion). To assess the effects L-Dopa, under chronic dopaminergic therapy randomly examined when OFF ON therapy. Finally, clinical-behavioral correlations investigated, primarily focusing on relationship between cardinal L-Dopa-responsive signs, bradykinesia rigidity. Compared HS, whole group showed reduced range velocity, alongside increased asymmetry gait. Additionally, distinct increase distortion was found patients. kinematic changes prominent stage progressively worsened owing involvement less affected hemibody. time- abnormalities comparable two (i.e., shoulder elbow). In subgroup treatment, restored patterns movements. alterations correlated with severity characterized by narrow, slow, irregular patterns. As progresses, deteriorate also hemibody, without any joint specificity. positive along significant correlation kinematics bradykinesia/rigidity scores points pathways pathophysiology PD.

Language: Английский

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Rethinking age barriers in Parkinson’s disease for deep brain stimulation

Neurochirurgie, Journal Year: 2025, Volume and Issue: unknown, P. 101665 - 101665

Published: March 1, 2025

Language: Английский

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The Effects of Deep Brain Stimulation on Balance in Parkinson’s Disease as Measured Using Posturography—A Narrative Review

Brain Sciences, Journal Year: 2025, Volume and Issue: 15(5), P. 535 - 535

Published: May 21, 2025

Background: Postural imbalance with falls affects 80% of patients Parkinson’s disease (PD) at 10 years. Standard PD therapies (e.g., levodopa and/or deep brain stimulation—DBS) are poor improving postural imbalance. Additionally, the mechanistic complexity interpreting control is a major barrier to our understanding treatment effects. In this paper, we review effects DBS on balance as measured using posturography. We also critically appraise quantitative measures and analyses used in these studies. Methods: A literature search was performed independently by 2 researchers PUBMED database. Thirty-eight studies included review, subthalamic nucleus (STN-) (n = 25), globus pallidus internus (GPi-) 6), ventral intermediate (VIM)/thalamus 2), pedunculopontine (PPN) 5). Results: STN- GPi-DBS reduce static sway mitigate increased from levodopa. STN-DBS impairs automatic responses perturbations, whilst has more neutral effect. may promote protective strategies following external perturbations but does not improve adaptation. The evidence regarding gait initiation less clear. Insufficient exists make conclusions VIM- PPN-DBS. Conclusions: have differing posturography, which suggests site-specific possibly non-dopaminergic mechanisms. Posturography tests should be utilised answer specific questions mechanisms DBS. recommend standardising posturography test conditions expert consensus greater long-term data collection, utilising ongoing registries.

Language: Английский

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Choroid plexus enlargement contributes to motor severity via regional glymphatic dysfunction in Parkinson’s disease

npj Parkinson s Disease, Journal Year: 2025, Volume and Issue: 11(1)

Published: May 22, 2025

Language: Английский

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