Kinematic but not clinical measures predict falls in Parkinson-related orthostatic hypotension
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Kinematic but not clinical measures predict falls in Parkinson‑related orthostatic hypotension Andrea Sturchio1,2,3 · Alok K. Dwivedi4 · Luca Marsili1 · Aaron Hadley5 · Gabriele Sobrero1,6 · Dustin Heldman5 · Simona Maule6 · Leonardo Lopiano7 · Cristoforo Comi8 · Maurizio Versino3,9 · Alberto J. Espay1 · Aristide Merola10 Received: 19 July 2020 / Revised: 18 September 2020 / Accepted: 21 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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. Keywords Parkinson’s disease · Orthostatic hypotension · Falls · Wearable sensors
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00415-020-10240-8) contains supplementary material, which is available to authorized users. * Aristide Merola [email protected] 1
Orthostatic hypotension (OH), defined as blood pressure (BP) drop of at least 20/10 mmHg (systolic/diastolic) within 3 min of standing from a supine position [1], is 5
Great Lakes NeuroTechnologies, Cleveland, OH, USA
6
Ambulatorio per le Disautonomie e l’Ipotensione Ortostatica, AOU Città della Salute e della Scienza di Torino, Turin, Italy
Department of Neurology, Gardner Family Center for Parkinson’s Disease and Movement Disorders, University of Cincinnat
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