Older Persons Displaying Parkinsonian Gait: Prediction and Explanation of the Recurrent Falling Phenomenon and Its Related Poor Prognosis

Abstract

Introduction: Parkinsonian gait in older persons is a major risk factor for recurrent falling. This prospective, longitudinal study (named EVAMAR-AGEX) aimed to validate the threshold value of two or more falls per year for distinguishing non-recurrent (NRF) from recurrent fallers (RF), to explore predictive factors for recurrent falling, and to identify factors which underlie the transition of patients from NRF to RF. The study took place over 2 years, with an intermediate analysis at 1 year of follow-up. Herein, we report results after 2 years of follow-up. Methods: Participants over the age of 65, diagnosed with parkinsonian gait, were followed over the course of 2 years. Induced parkinsonian syndrome and uncontrolled orthostatic hypotension were excluded. Assessments of motor, visual, and cognitive functions were carried out during visits at baseline. Between visits at 12 and 24 months of follow-up, data were collected by phone call every 2 months (falls, traumatic falls, hospitalizations, cognitive fluctuations, delirium, and mortality). Odds ratios (ORs) for a panel of predictive factors for recurrent falling were established using a Bayesian model. Results: Sixty-six of the 79 initially enrolled participants progressed to the second year of the study, with a mean age of 80.57 (SD 6.3), 56% male, presenting parkinsonian gait (53% Parkinson’s disease, 15% atypical neurodegenerative parkinsonism, 21% vascular parkinsonism, and 11% diffuse Lewy body disease). At 2 years of follow-up, 67% were RF. Univariate analysis revealed a previous history of falls to be the most significant predictive factor of recurrent falls (OR 13.16, credibility interval [CrI] [95%] 4.04–53.73), and this was reinforced at 2 years of follow-up compared to the intermediate 1-year analysis (OR 11.73, CrI [95%] 4.33–35.28). Multivariate analysis confirmed a previous history of falls (OR 13.20, CrI [95%] 3.29–72.08) and abnormal posture (OR 3.59, CrI [95%] 1.37–11.26) to be predictive factors for recurrent falling. Cognitive decline and fluctuating cognition were associated with the transition from NRF to RF (−3.5 MMSE points for participants transitioning from NRF to RF). Conclusion: Within this population of older persons presenting parkinsonian gait, a previous history of falls and abnormal posture may be used to easily identify individuals at risk of recurrent falls. Cognitive decline and fluctuations may underlie the transition of NRF to RF.