Abstract
Pathophysiological understanding of gait and balance disorders in Parkinson’s disease is insufficient and late recognition of fall risk limits efficacious follow‐up to prevent or delay falls. We show a distinctive reduction of glucose metabolism in the left posterior parietal cortex, with increased metabolic activity in the cerebellum, in parkinsonian patients 6–8 months before their first fall episode. Falls in Parkinson’s disease may arise from altered cortical processing of body spatial orientation, possibly predicted by abnormal cortical metabolism.
Highlights
Falls and fall-related injuries are a major cause of disability in subjects with Parkinson’s disease (PD)
While nigrostriatal dopaminergic denervation does not differ between the PD patients with and without falls,[6] functional brain imaging studies has recently showed a direct involvement of cortical areas in PD fallers.[6,7]
analysis of variance (ANOVA) analysis with SPM and VOI revealed that glucose metabolism significantly differed between the three groups in the left parietal cortex and bilateral cerebellar lobi and post hoc two-sample t-tests showed that Fallers versus Non-fallers or versus healthy subjects (HC) showed hypometabolism in the left inferior and superior parietal lobules and increased bilateral cerebellar glucose consumption
Summary
Falls and fall-related injuries are a major cause of disability in subjects with Parkinson’s disease (PD). Fall rates in PD range from 35 to 90% and increase during the disease course.[1] Despite detailed testing of gait and balance, the specific factors that are critical to fall prediction and prevention in PD remain elusive[2] and the best single variable to predict falls is two or more falls in the previous year (odds ratio 1.5 or higher).[3,4,5] Late recognition of patients at risk of falls prevents their timely treatment and is mainly related to the unclear pathophysiology of balance dysfunction in PD. We investigated the brain metabolic alterations in PD patients at high risk of fall prior to the occurrence of the first fall
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