%0 Journal Article
%T Cardiovascular autonomic neuropathy and falls in Parkinson disease: a prospective cohort study.
%A Romagnolo A
%A Zibetti M
%A Merola A
%A Canova D
%A Sarchioto M
%A Montanaro E
%A Artusi CA
%A Vallelonga F
%A Maule S
%A Lopiano L
%J J Neurol
%V 266
%N 1
%D Jan 2019
%M 30382389
%F 6.682
%R 10.1007/s00415-018-9104-4
%X <B>BACKGROUND: </B>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><B>METHODS: </B>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><B>RESULTS: </B>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><B>CONCLUSIONS: </B>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.