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Kinematic but not clinical measures predict falls in Parkinson-related orthostatic hypotension

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Abstract

Objective

We sought to test the hypothesis that technology could predict the risk of falls in Parkinson’s disease (PD) patients with orthostatic hypotension (OH) with greater accuracy than in-clinic assessment.

Methods

Twenty-six consecutive PD patients with OH underwent clinical (including home-like assessments of activities of daily living) and kinematic evaluations of balance and gait as well as beat-to-beat blood pressure (BP) monitoring to estimate their association with the risk of falls. Fall frequency was captured by a diary collected prospectively over 6 months. When applicable, the sensitivity, specificity, and diagnostic accuracy were measured using the area under the receiver operating characteristics curve (AUC). Additional in-clinic assessments included the OH Symptom Assessment (OHSA), the OH Daily Activity Score (OHDAS), and the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS).

Results

The prevalence of falls was 53.8% over six months. There was no association between the risk of falls and test of gait and postural stability (p ≥ 0.22) or home-like activities of daily living (p > 0.08). Conversely, kinematic data (waist sway during time-up-and-go, jerkiness, and centroidal frequency during postural sway with eyes-opened) predicted the risk of falls with high sensitivity and specificity (> 80%; AUC ≥ 0.81). There was a trend for higher risk of falls in patients with orthostatic mean arterial pressure ≤ 75 mmHg.

Conclusions

Kinematic but not clinical measures predicted falls in PD patients with OH. Orthostatic mean arterial pressure ≤ 75 mmHg may represent a hemodynamic threshold below which falls become more prevalent, supporting the aggressive deployment of corrective measures.

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Acknowledgements

We acknowledge the contribution of patients who took part in this study and the healthcare professionals working at the Gardner’s Center for Movement Disorders at the University of Cincinnati.

Funding

This work has been supported by the National Institute of Health (NIH), Grant KL2 TR001426.

Author information

Authors and Affiliations

  1. Department of Neurology, Gardner Family Center for Parkinson’s Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA

    Andrea Sturchio, Luca Marsili, Gabriele Sobrero & Alberto J. Espay

  2. University of Pavia, Pavia, Italy

    Andrea Sturchio

  3. Neurology Unit, Varese ASST Sette Laghi, Ospedale di Circolo, Varese, Italy

    Andrea Sturchio & Maurizio Versino

  4. Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA

    Alok K. Dwivedi

  5. Great Lakes NeuroTechnologies, Cleveland, OH, USA

    Aaron Hadley & Dustin Heldman

  6. Ambulatorio per le Disautonomie e l’Ipotensione Ortostatica, AOU Città della Salute e della Scienza di Torino, Turin, Italy

    Gabriele Sobrero & Simona Maule

  7. Department of Neuroscience “Rita Levi Montalcini”, University of Torino, Turin, Italy

    Leonardo Lopiano

  8. Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy

    Cristoforo Comi

  9. DMC, University of Insubria, Varese, Italy

    Maurizio Versino

  10. Department of Neurology, Wexner Medical Center, Ohio State University, Columbus, OH, USA

    Aristide Merola

Authors
  1. Andrea Sturchio
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  2. Alok K. Dwivedi
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  7. Simona Maule
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  8. Leonardo Lopiano
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  12. Aristide Merola
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Contributions

AS contributed to concept and design of the manuscript, analyzed and interpreted data, and drafted/revised the manuscript for content. AKD analyzed and interpreted data and revised the manuscript for content. LM, AH, GS and DH contributed to acquisition of data, interpreted data, and revised the manuscript for content. SM, LL, CC, MV, and AJE interpreted data and revised the manuscript for content. AM helped in study concept and design, analyzed and interpreted data and drafted/revised the manuscript for content.

Corresponding author

Correspondence to Aristide Merola.

Ethics declarations

Conflicts of interest

Dr. Sturchio has no financial conflicts to disclose. Prof. Dwivedi is supported as a co-investigator by the NIH (1 R21 HL143030-01) and (R21 AI133207) grants. He is also currently serving as a statistician in CPRIT-funded studies (PP200006, PP190058, PP180003, and PP170068). Dr. Dwivedi is also an Adjunct Associate Professor in the department of neurology and rehabilitation medicine, University of Cincinnati. Dr. Marsili has no financial conflicts to disclose. Dr. Hadley owns stock in Great Lakes NeuroTechnologies and has received compensation for employment. Dr. Hadley has received grant funding from the NIH. Dr. Sobrero has no financial conflicts to disclose. Dr. Heldman serves on the board of directors of Great Lakes NeuroTechnologies. He also owns stock in Great Lakes NeuroTechnologies and has received compensation for employment. Dr. Maule has no financial conflicts to disclose. Dr. Lopiano has received grant support from Abbvie, Zambon and personal compensation from Abbvie, Zambon, DOC, Bial, UCB. Dr. Comi has received grant support from the “Agenzia Italiana del Farmaco” and from “Fondazione Cariplo”; and travel grants from Zambon S.P.A. and Mylan. Dr. Versino received academic fund support from Chiesi Farmaceutici SpA. Dr. Espay has received grant support from the NIH, Great Lakes Neurotechnologies and the Michael J Fox Foundation; personal compensation as a consultant/scientific advisory board member for Abbvie, TEVA, Impax, Acadia, Acorda, Cynapsus/Sunovion, Lundbeck, and USWorldMeds; publishing royalties from Lippincott Williams & Wilkins, Cambridge University Press, and Springer; and honoraria from Abbvie, UCB, USWorldMeds, Lundbeck, Acadia, the American Academy of Neurology, and the Movement Disorders Society. He serves as Associate Editor of the Journal of Clinical Movement Disorders and on the editorial boards of JAMA Neurology, the Journal of Parkinson’s Disease and Parkinsonism and Related Disorders. Dr. Merola is supported by NIH (KL2 TR001426) and has received speaker honoraria from CSL Behring, Abbvie, Abbott, Theravance, and Cynapsus Therapeutics. He has received grant support from Lundbeck and Abbvie.

Ethics approval

The study received IRB/ethics committee approval at all participating centers and was conducted in accordance with the Good Clinical Practice and the International Conference on Harmonization guidelines and any applicable national and local regulations. The authors declare that they acted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

Data access and responsibility statement

A. Merola had full access to all the data in the study and takes responsibility for the integrity of the data, the accuracy of the data analysis, and the conduct of the research. He has the right to publish any and all data, separate and apart from the guidance of any sponsor.

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Sturchio, A., Dwivedi, A.K., Marsili, L. et al. Kinematic but not clinical measures predict falls in Parkinson-related orthostatic hypotension. J Neurol 268, 1006–1015 (2021). https://doi.org/10.1007/s00415-020-10240-8

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  • DOI: https://doi.org/10.1007/s00415-020-10240-8

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