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ABSTRACTBackground:Fear of falling in Parkinson's disease (PD) has been suggested as predictor of future falling. The purpose of this study was to compare fear of falling score after two years of follow-up with those observed at baseline and to assess factors associated with change in fear of falling over time.Methods: A total of 120 consecutive persons with PD were recruited and followed for two years. Fear of falling was assessed by using the 10-item Falls Efficacy Scale (FES). Occurrence of falling was registered during the first year of follow-up.Results: After two years, the average FES score statistically significantly changed (p = 0.003) from 30.5 to 37.5 out of 100 (increase of 22.9%). We observed that median scores of all FES items, except for "Preparing a meal, not requiring carrying of heavy or hot objects" and "Personal grooming," significantly increased after two-year follow-up. After accounting for age, gender, PD duration, levodopa dosage, Hoehn and Yayhr stage, Unified Parkinson's Disease Rating Scale score three, depression, anxiety, and falling, we observed that sustaining greater number of falls in the first year of follow-up was associated with higher increase in FES score after two years (odds ratio 3.08, 95% confidence interval 1.30-4.87).Conclusion: After two years of follow-up, we observed a decrease in confidence at performing nearly all basic daily activities. Fall prevention programs should be prioritized in management of PD. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess whether various domains related to health ‐ related quality of life could be predictive of recurrent falls among persons with Parkinson's disease (PD) during a 1 ‐ year follow ‐ up study. Methods: A total of 120 consecutive persons with PD who had denied falling in past 6 months were recruited at regular check ‐ ups at the Department of Movement Disorders, Neurology Clinic, Clinical Center of Serbia in Belgrade, from 15 August 2011 to 15 December 2012. At baseline, study participants were clinically assessed. Health ‐ related quality of life was evaluated with the generic 36 ‐ item Short Form Health Survey. Participants were prospectively followed for 1 year, and occurrence of falls was registered. Results: The median age of subjects was 60.0 years, with a median disease duration of 4.0 years. Of 120 persons with PD, 42 (35%) experienced falls during the 12 ‐ month study period, including 23 (19.2%) who fell repeatedly. After adjustment for gender, age, PD duration, levodopa dosage, Hoehn and Yahr stage, Unified Parkinson's Disease Rating Scale I – IV, Hamilton Depression Rating Scale, and Hamilton Anxiety Rating Scales, we identified the 36 ‐ item Short Form Health Survey domains of role physical (P = 0.033) and vitality (P = 0.019) as being associated with recurrent falls of persons with PD within the 1 ‐ year follow ‐ up period. Conclusion: Baseline 36 ‐ item Short Form Health Survey scores regarding both the physical and mental components of overall health may be related to recurrent falling among persons with PD. These HRQoL domains could be considered as potential markers for persons with PD who are prone to recurrent falls. [ABSTRACT FROM AUTHOR]

Introduction It has been demonstrated that various domains of health-related quality of life (HRQoL) have predictive value in progression of disability and depression in a neurological setting. The aim of this study was to assess potential predictive value of domains of HRQoL in occurrence of falls among persons with Parkinson's disease (PD) over one year of follow-up. Methods The study comprised cross-sectional design at baseline and 1-year prospective cohort study. Those who denied having fallen in the past 6 months were followed for one year, while participants were asked to record falls prospectively in a falls diary for a year. A total of 300 consecutive PD outpatients without cognitive impairment were recruited from August 15, 2011 to December 15, 2012 in the outpatient Department of Movement Disorders, Institute of Neurology, Clinical Center of Serbia in Belgrade. The HRQoL was evaluated using the SF-36 questionnaire. Results All domains of the SF-36, except Role Emotional, were significantly lower among fallers. After controlling for potential confounding factors, the domain of Role Physical (p = 0.027), Physical Composite Score (p = 0.023) and the total SF-36 score (p = 0.029) were significant predictors of occurrence of falls within one year of follow-up. Conclusion Assessment of quality of life represents an additional tool to the established measures of clinical course of the disease and could provide further insight in complex distinction of risk factors for falling in PD. [ABSTRACT FROM AUTHOR]

Aim The aim of the present study was to estimate fall frequency as well as demographic and clinical factors related to falling in a cohort of Serbian patients with Parkinson's disease ( PD). Method The cross-sectional study comprised 300 consecutive patients recruited at the Neurology Clinic in Belgrade, Serbia, from August 2011 to December 2012. Data were acquired though detailed interviews, while a history of falling referred to the period of 6 months before testing. After a interview related to the circumstances of the last fall sustained by PD patients, the participants were evaluated with the Mini-Mental State Examination, the Unified Parkinson's Disease Rating Scale, the Hoehn and Yahr scale, the Falls Efficacy Scale and the Self-Assessment Disability Scale, New Freezing of Gait questionnaire for frequency and impact of freezing, and the Hamilton Depression and the Hamilton Anxiety Rating Scale. Results A total of 60% of individuals reported a fall in the 6-month period before testing. Multivariate regression showed that patients with PD who had a Self-Assessment Disability Scale score of ≥56 and Unified Parkinson's Disease Rating Scale total score of ≥69 were 2.04 and 3.32 times more likely to fall, respectively (95% CI 1.10-3.79, P = 0.023 for Self-Assessment Disability Scale and 95% CI 1.83-6.00, P = 0.001 for Unified Parkinson's Disease Rating Scale). In contrast, a decrease of risk for falling by 57% was observed among those who practiced regular physical activity before the onset of PD (95% CI 0.23-0.80, P = 0.008). Conclusion There is a strong relationship between falling and self-perceived disability, whereas previous physical exercise had a protective effect. Geriatr Gerontol Int 2015; 15: 472-480. [ABSTRACT FROM AUTHOR]

Falls represent continuing, disabling and costly problem in Parkinson’s disease (PD). The study was carried out at the Neurology Clinic in Belgrade from August 2011 to December 2012. As many as 180 community dwelling persons with PD aged 22-83 years who sustained a fall in past 6 months were included. Characteristics of the most recent fall were obtained through detailed interviews. Inclusion criteria were: Mini Mental State Examination (MMSE) ≥24, ability to walk independently for at least 10 m and ability to statically stand for at least 90 s. Exclusion criteria were: presence of other neurologic as well as psychiatric, visual, audio-vestibular and orthopedic impairments. Falls more frequently took place outside (57.2%) and in the morning (53.9%). As much as 38.9% of persons with PD sustained an injury. Soft-tissue contusion was the most common injury (71.8%) both after indoor and outdoor falls. Fractures accounted for 5% of all fall-related injuries. All the fractures were either arm, clavicle or rib fractures. Tripping was identified as risk factor for outdoor falls (OR = 7.90; 95% confidence interval [95% CI] 3.21-19.39; p = 0.001). In contrast, lower extremity weakness (OR = 0.20; 95% CI 0.05-0.72; p = 0.015) and internal sense of sudden loss of balance (OR = 0.19; 95% CI 0.05-0.73; p = 0.015) were risk factors for indoor falls. To accomplish long-term results, development of particular prevention programs for persons with PD who fall at home vs. outdoors is recommended. [ABSTRACT FROM AUTHOR]

Progressive supranuclear palsy (PSP) and parkinsonian subtype of multiple system atrophy (MSA-P) are, after Parkinson's disease (PD), the most common forms of neurodegenerative parkinsonism. Clinical heterogeneity of PSP includes two main variants, Richardson syndrome (PSP-RS) and PSP-parkinsonism (PSP-P). Clinical differentiation between them may be impossible at least during the first 2 years of the disease. Little is known about the differences in natural course of PSP-RS and PSP-P and, therefore, in this study we prospectively followed the clinical outcomes of consecutive, pathologically unconfirmed patients with the clinical diagnoses of PSP-RS (51 patients), PSP-P (21 patients) and MSA-P (49 patients). Estimated mean survival time was 11.2 years for PSP-P, 6.8 years for PSP-RS, and 7.9 years for MSA-P, where a 5-year survival probabilities were 90, 66 and 78 %, respectively. More disabling course of PSP-RS compared to PSP-P was also highlighted through the higher number of milestones reached in the first 3 years of the disease, as well as in the trend to reach all clinical milestones earlier. We found that PSP-P variant had a more favorable course with longer survival, not only when compared to PSP-RS, but also when compared to another form of atypical parkinsonism, MSA-P. [ABSTRACT FROM AUTHOR]

Aims: To investigate association of the Val66Met polymorphism in the brain-derived neurotrophic factor (BDNF) gene with clinical features in Serbian patients with Parkinson's disease (PD). Methods: The study comprised 177 consecutive PD patients. A comprehensive set of clinical scales was applied in all patients. The controls (n = 366) were recruited among students. Single nucleotide polymorphisms (SNPs; rs6265) were analyzed using TaqMan assays. Results: PD patients (118 males) were aged 58.9 ± 10.9 years, with a mean age at onset of 49.0 ± 11.2 years. PD patients and controls had a similar distribution of genotypes and allele frequencies. The presence of the Met allele did not influence the clinical characteristics of PD patients (age at onset, family history, gender, disease duration, form of the disease, initial symptoms, cognitive abilities, depression, anxiety, disease severity, severity of motor and prevalence of nonmotor symptoms, and development of motor complications). Conclusion: Overall, the Val66Met polymorphism did not modify the clinical features in PD patients. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Aim The aim of the present study was to assess the validity and reliability of the Falls Efficacy Scale ( FES) in Parkinson's disease ( PD) patients in Serbia. Methods A cross-sectional study was carried out at the Clinic for Neurology, between June 2011 and June 2012. A total of 201 consecutive PD outpatients were recruited. The inclusion criteria were: ability to walk independently for at least 10 m, ability to stand for at least 90 s and a Mini- Mental State Examination score >24. The exclusion criteria were: the presence of other major neurological, psychiatric, visual, audio-vestibular and orthopedic disturbances. The 10-item FES was translated according to internationally-accepted methodology. The internal reliability of the Serbian version of the FES was evaluated using Cronbach's alpha coefficient. Reproducibility of the FES was evaluated using the Spearman- Brown coefficient. To evaluate construct validity, an exploratory factor analysis (principal component analysis, varimax rotation) was carried out. Results The internal consistency of the Serbian version of the FES was 0.98. Age, duration of disease, Hoehn and Yahr stage, Unified Parkinson's Disease Rating Scale motor score, history of falls, and the Hamilton depression and anxiety scores were significantly correlated with the total FES score. On factor analysis, all 10 items were compact in a one-factor cluster, with an explained variance of 85%. Spearman-Brown's correlation coefficient between the total scores was 0.99. Conclusions The psychometric characteristics of the Serbian version of the FES have excellent reliability and validity as an instrument for measuring the fear of falling in PD patients. Geriatr Gerontol Int 2013; 13: 936-941. [ABSTRACT FROM AUTHOR]

The aims of this study were to compare clinical and fall characteristics of single and recurrent falls among persons with PD and to evaluate factors associated with recurrent falls. A total of 120 consecutive persons with PD, who denied having fallen in the past 6 months, were recruited. Occurrence of falling was registered during one year. Each person was given a “fall diary” with the aim at writing characteristics of the fall and contacted by telephone each month. Over one year of follow-up 42 persons with PD (35.0%) reported falling. Of 42 persons, 19 (45.2%) went on to become single and 23 (54.8%) went on to become recurrent fallers. Indoor falls were more common among single fallers, whilst outdoor falls were more common among recurrent fallers ( p = 0.017). Slipping and freezing of gait was more common among single fallers ( p = 0.035 and p = 0.024, respectively). Lower extremity weakness was more frequent among recurrent fallers ( p = 0.023). The most common injury both among single and recurrent fallers was the soft-tissue contusion. The only factor associated with recurrent falling among persons with PD, who did not fall in past 6 months before the start of follow-up, was worse motor performance as measured by the UPDRS III score (odds ratio [OR] = 1.06, 95% confidence interval [CI] 1.01–1.11, p = 0.022). These results could be used in selection of persons with PD to enroll in fall prevention programs. [ABSTRACT FROM AUTHOR]