Background

Executive dysfunction and risk of falling are hallmarks of Parkinson’s disease (PD). However, it is unclear how executive dysfunction predisposes people with PD to falling.

Objectives

To: (i) identify sensorimotor, balance, and cardiovascular risk factors for falls that discriminate between those with normal executive function and those with mild and marked executive dysfunction in people with PD and (ii) determine whether mild and marked executive dysfunction are significant risk factors for falls when adjusting for PD duration and severity and freezing of gait (FOG).

Methods

Using the Frontal Assessment Battery, 243 participants were classified into normal executive function (n = 87), mild executive dysfunction (n = 100), and marked executive dysfunction (n = 56) groups. Participants were asked if they had episodes of FOG in the last month and were assessed with the Movement Disorders Society – Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), the Hoehn and Yahr Scale, the physiological profile assessment, and tests of orthostatic hypotension, coordinated stability, and gait and were then followed-up prospectively for falls for 32–52 weeks.

Results

Several PD-specific (elevated Hoehn and Yahr stage, higher MDS-UPDRS scale scores, a history of FOG, Postural Instability and Gait Difficulty subtype, and longer PD duration), sensorimotor (poor vision, knee extension weakness, slow simple reaction time), and balance (greater postural sway and poor controlled leaning balance) factors discriminated among the normal executive function and mild and marked executive dysfunction groups. Fall rates (mean ± SD) differed significantly among the groups (normal executive function: 1.0 ± 1.7; mild executive dysfunction: 2.8 ± 5.2; marked executive dysfunction: 4.7 ± 7.3) with the presence of both mild and marked executive dysfunction identified as significant risk factors for falls when adjusting for three measures of PD severity (Hoehn and Yahr scale scores, disease duration, and FOG).

Conclusions

Several PD-specific, sensorimotor, and balance factors differed significantly among the normal, mild, and marked executive dysfunction groups and both mild and marked executive dysfunction were identified as independent risk factors for falls in people with PD.

中文翻译：

---

帕金森病患者出现轻度和明显的执行功能障碍和跌倒

 背景

执行功能障碍和跌倒风险是帕金森病 (PD) 的标志。然而，目前尚不清楚执行功能障碍如何使帕金森病患者容易跌倒。

 目标

目的：(i) 识别跌倒的感觉运动、平衡和心血管危险因素，以区分 PD 患者中具有正常执行功能的患者和具有轻度和明显执行功能障碍的患者，以及 (ii) 确定轻度和明显执行功能障碍是否是显着风险调整 PD 持续时间、严重程度以及步态冻结 (FOG) 时跌倒的因素。

 方法

使用额叶评估系统，243 名参与者被分为正常执行功能组 (n = 87)、轻度执行功能障碍组 (n = 100) 和明显执行功能障碍组 (n = 56)。参与者被询问是否在上个月出现过 FOG 发作，并接受了运动障碍协会统一帕金森病评定量表 (MDS-UPDRS)、Hoehn 和 Yahr 量表、生理特征评估以及直立性低血压测试的评估，协调稳定性和步态，然后对跌倒进行前瞻性随访 32-52 周。

 结果

几种 PD 特异性（Hoehn 和 Yahr 阶段升高、MDS-UPDRS 量表分数较高、FOG 病史、姿势不稳定性和步态困难亚型以及 PD 持续时间较长）、感觉运动（视力差、膝关节伸展无力、简单反应时间慢）和平衡（较大的姿势摇摆和控制倾斜平衡较差）因素区分正常执行功能组和轻度和明显执行功能障碍组。各组之间的跌倒率（平均值±标准差）存在显着差异（正常执行功能：1.0 ± 1.7；轻度执行功能障碍：2.8 ± 5.2；显着执行功能障碍：4.7 ± 7.3），其中轻度和显着执行功能障碍的存在均被认为是显着的调整 PD 严重程度的三项指标（Hoehn 和 Yahr 量表评分、疾病持续时间和 FOG）时发生跌倒的危险因素。

 结论

一些帕金森病特异性、感觉运动和平衡因素在正常、轻度和明显执行功能障碍组之间存在显着差异，并且轻度和明显执行功能障碍均被确定为帕金森病患者跌倒的独立危险因素。