{Reference Type}: Journal Article
{Title}: Cardiovascular autonomic neuropathy and falls in Parkinson disease: a prospective cohort study.
{Author}: Romagnolo A;Zibetti M;Merola A;Canova D;Sarchioto M;Montanaro E;Artusi CA;Vallelonga F;Maule S;Lopiano L;
{Journal}: J Neurol
{Volume}: 266
{Issue}: 1
{Year}: Jan 2019
{Factor}: 6.682
{DOI}: 10.1007/s00415-018-9104-4
{Abstract}: <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.