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COMMENTARY
Year : 2021  |  Volume : 69  |  Issue : 3  |  Page : 648-649

Clinical Relevance of Fear of Falling in Patients with Parkinson's Disease


Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Republic of Korea

Date of Submission02-Jun-2021
Date of Decision02-Jun-2021
Date of Acceptance02-Jun-2021
Date of Web Publication24-Jun-2021

Correspondence Address:
Dr. Kyum-Yil Kwon
Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul
Republic of Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.319243

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How to cite this article:
Kwon KY. Clinical Relevance of Fear of Falling in Patients with Parkinson's Disease. Neurol India 2021;69:648-9

How to cite this URL:
Kwon KY. Clinical Relevance of Fear of Falling in Patients with Parkinson's Disease. Neurol India [serial online] 2021 [cited 2021 Jul 24];69:648-9. Available from: https://www.neurologyindia.com/text.asp?2021/69/3/648/319243




Albay et al. conducted an interesting study to investigate the association between fear of falling (FOF) and health-related quality of life (HRQoL) in patients with Parkinson's disease (PD).[1] This study included not only PD patients but also healthy controls, revealing that PD patients showed higher scores of FOF, compared with controls. Next, patients with PD were divided into two subgroups: PD patients with FOF versus those without FOF. They found that FOF was significantly related to disability level and disease severity. Moreover, FOF was found to be an independent factor influencing the HRQoL in patients with PD.

PD is a neurodegenerative disorder characterized by cardinal motor symptoms including tremor, rigidity, bradykinesia, and gait disturbance. Patients with PD also have a variety of non-motor symptoms including cognitive impairment, sleep problems, autonomic dysfunction, and mood disorders. Until now, there is no treatment to modify the pathologic changes of the disease. Accordingly, the therapeutic goal of PD is no cure, but care. Many patients with PD suffer from various nonmotor symptoms including depression, fatigue, sleep disturbance, or constipation beyond motor disability in their daily lives. Therefore, nowadays, many clinicians and researchers are interested in the point of HRQoL beyond motor symptoms in treating patients with PD. Appropriate attention for both motor and non-motor symptoms is crucial in patients with PD.

Factors affecting HRQoL in patients with PD include not only motor symptoms and/or disease severity but also various non-motor symptoms including anxiety, depression, apathy. In particular, gait impairment and falls are significant determinants of lowering HRQoL in patients with PD.[2] Falls in patients with PD may result in severe fractures to cause the limitation of mobility. Therefore, fall-related risk factors in patients with PD are highly linked to HRQoL-related factors. To decrease or manage risk factors for falling is an important method not to worsen HRQoL in patients with PD.

In general, representative risk factors of falling in patients with PD include a history of falls, freezing of gait, and FOF.[3] Compared with previous falls or freezing of gait, the clinical relevance or importance of FOF is relatively less investigated. Besides, a previous study reported that even patients with de novo PD reported higher scores of FOF, compared with healthy controls.[4] Whereas falls and freezing of gait are common in relatively advanced stages of PD, rather than the early stages of PD. Collectively, it is reasonable to infer that the accurate assessment of FOF might be helpful to identify high-risk patients for falling in any stage of PD. In addition, clinical trials to lower FOF in patients with PD need to be necessary, since the recuperation of FOF may not only prevent fall events but also improve HRQoL in patients with PD.

Anxiety and fear are interrelated, thereby it is very difficult to distinguish between anxiety and FOF. It has been widely accepted that patients with PD tend to have more anxiety compared with the normal elderly. However, FOF, apart from anxiety, has been studied as another independent factor.[1],[3] Accordingly, FOF could be regarded as one of the non-motor symptoms in PD. On the other hand, Grimbergen et al. showed that FOF, rather than actual falling, was more closely associated with HRQoL,[5] although FOF is significantly connected with falls in patients with PD. Taken together, these findings imply that FOF is a linkage between the non-motor aspect (i.e., fear) and the motor aspect (i.e., fall).

In conclusion, FOF is one of the fall risk factors and is significantly associated with HRQoL in patients with PD. Besides, FOF could be simply assessed using a questionnaire-based survey in any clinical stage of the disease. Therefore, not only clinicians but also researchers need to consider FOF as an important indicator in managing patients with PD more appropriately.



 
  References Top

1.
Albay VB, Tutuncu M. Fear of Falling: An Independent Factor Affecting Health- Related Quality of Life in Patients with Parkinson's Disease. Neurol India 2021;69:643-7.  Back to cited text no. 1
  [Full text]  
2.
Soh SE, Morris ME, McGinley JL. Determinants of health-related quality of life in Parkinson's disease: A systematic review. Parkinsonism Relat Disord 2011;17:1-9.  Back to cited text no. 2
    
3.
Kwon KY, Park S, Lee EJ, Lee M, Ju H. Association of fall risk factors and non-motor symptoms in patients with early Parkinson's disease. Sci Rep 2021;11:5171.  Back to cited text no. 3
    
4.
Kwon KY, Lee HM, Kang SH, Pyo SJ, Kim HJ, Koh SB. Recuperation of slow walking in de novo Parkinson's disease is more closely associated with increased cadence rather than with expanded stride length. Gait Posture 2017;58:1-6.  Back to cited text no. 4
    
5.
Grimbergen YA, Schrag A, Mazibrada G, Borm GF, Bloem BR. Impact of falls and fear of falling on health-related quality of life in patients with Parkinson's disease. J Parkinsons Dis 2013;3:409-13.  Back to cited text no. 5
    




 

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