Within-subject variation in the cognitive timed up and go test as an explanatory variable in fall risk in patients with parkinson’s disease
DOI:
https://doi.org/10.2340/16501977-2874Keywords:
gait, risk of falling, variability, Parkinson’s disease, dual task, postural balance, Timed Up and GoAbstract
Objective: To explore the use of within-subject variation in the Cognitive Timed Up and Go test (Cognitive TUGWSV) as an explanatory variable in fall risk in the Parkinson’s disease population.
Design: Cross-sectional study.
Methods: Fifty-three patients with Parkinson’s disease completed 3 trials of the Cognitive TUGWSV. Within-subject variation was calculated using the standard deviation of an individual’s repeated measurements, and compared on the basis of the fall history reported in the previous 6 months. Participants who reported < 2 falls were classified as “non-recurrent fallers” (n = 31) and those who reported ≥ 2 falls were classified as “recurrent fallers” (n = 22). Univariate and a multivariate logistic regression were used to investigate the statistical impact of the Cognitive TUGWSV as an explanatory variable in fall risk. Discriminative ability and cut-off score were determined based on receiver operating characteristic analysis.
Results: There was a significant difference between groups in the Cognitive TUGWSV (p = 0.002). Univariate logistic regression indicated a significant association between Cognitive TUGWSV and fall risk (χ2=12.365, p < 0.001), with an odds ratio of 2.5 (95% confidence interval (95% CI) = 1.34–4.65). Multivariate logistic regression showed that body mass index (BMI), Falls Efficacy Scale-International (FES-I), Cognitive TUGWSV, and the mean velocity of the centre of foot pressure under closed eyes condition (Velocity COP (CE)) were significant explanatory variables in fall risk. Cognitive TUGWSV was the most important independent variable. Receiver operating characteristic analysis revealed an acceptable discriminative power (area under the curve (AUC) = 0.757, 95% CI = 0.619–0.864, p < 0.001) and a cut-off point of 1.53 s.
Conclusion: A higher Cognitive TUGWSV correlated significantly with higher fall risk. Thus, diagnostic tests and exercise programmes could consider Cognitive TUGWSV when assessing fall risk in the Parkinson’s disease population.
Lay Abstract
Motor deficits in patients with Parkinson’s disease usually worsen when tasks are performed simultaneously or under maximal challenge conditions. Assessment of these motor complications has an important role in the prediction of fall risk. A range of parameters is used to assess motor alterations. Among them, within-subject variation is normally used as a parameter of reliability in validation studies. Nevertheless, the use of within-subject variation during a single session in the Timed Up and Go test with the addition of a cognitive dual task (Cognitive TUGwsv) performed at maximum speed has not yet been studied as a predictor of fall risk in the Parkinson’s disease population. The results of this study support the hypothesis that a higher Cognitive TUGwsv is related to a higher risk of falling in patients with Parkinson’s disease. Therefore, health professionals could consider this variable when assessing the risk of falling in this population.
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References
GBD 2016 Parkinson's Disease Collaborators. Global, regional, and national burden of Parkinson's disease, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2018; 17: 939-953.
Jankovic J. Parkinson's disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry 2008; 79: 368-376.
https://doi.org/10.1136/jnnp.2007.131045
Schoneburg B, Mancini M, Horak F, Nutt JG. Framework for understanding balance dysfunction in Parkinson's disease. Mov Disord 2013; 28: 1474-1482.
https://doi.org/10.1002/mds.25613
Stolze H, Klebe S, Zechlin C, Baecker C, Friege L, Deuschl G. Falls in frequent neurological diseases: prevalence, risk factors and aetiology. J Neurol 2004; 251: 79-84.
https://doi.org/10.1007/s00415-004-0276-8
Latt MD, Lord SR, Morris JGL, Fung VSC. Clinical and physiological assessments for elucidating falls risk in Parkinson's disease. Mov Disord 2009; 24: 1280-1289.
https://doi.org/10.1002/mds.22561
Keloth SM, Viswanathan R, Jelfs B, Arjunan S, Raghav S, Kumar D. Which gait parameters and walking patterns show the significant differences between parkinson's disease and healthy participants? Biosensors 2019; 9: 1-19.
https://doi.org/10.3390/bios9020059
Bloem BR, Marinus J, Almeida Q, Dibble L, Nieuwboer A, Post B, et al. Measurement instruments to assess posture, gait, and balance in Parkinson's disease: critique and recommendations. Mov Disord 2016; 31: 1342-1355.
https://doi.org/10.1002/mds.26572
Vance RC, Healy DG, Galvin R, French HP. Dual tasking with the timed "up & go" test improves detection of risk of falls in people with Parkinson disease. Phys Ther 2015; 95: 95-102.
https://doi.org/10.2522/ptj.20130386
Sousa NMF, Macedo RC. Relationship between cognitive performance and mobility in patients with Parkinson's disease: a cross-sectional study. Dement Neuropsychol 2019; 13: 403-439.
https://doi.org/10.1590/1980-57642018dn13-040006
Asai T, Misu S, Oshima K, Fukumoto Y, Yonezawa Y, Matsuo A. Association of fall history with the Timed Up and Go test score and the dual task cost: a cross-sectional study among independent community-dwelling older adults. Geriatr Gerontol Int 2018; 18: 1189-1193.
https://doi.org/10.1111/ggi.13439
Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC Geriatr 2014; 14: 1-14.
https://doi.org/10.1186/1471-2318-14-14
Lennon S, Ramdharry G, Verheyden G. Physical management for neurological conditions. Poland: Elsevier Health Sciences; 2018.
Hopkins WG. Measures of reliability in sports medicine and science. Sport Med 2000; 30: 1-15.
https://doi.org/10.2165/00007256-200030010-00001
Arias P, Robles-garcía V, Espinosa N, Corral Y, Cudeiro J. Validity of the finger tapping test in Parkinson's disease, elderly and young healthy subjects: is there a role for central fatigue? Clin Neurophysiol 2012; 123: 2034-2041.
https://doi.org/10.1016/j.clinph.2012.04.001
Hausdorff JM, Rios DA, Edelberg HK. Gait variability and fall risk in community-living older adults : a 1-year prospective study. Arch Phys Med Rehabil 2001; 82: 1050-1056.
https://doi.org/10.1053/apmr.2001.24893
Nordin E, Rosendahl E, Lundin-Olsson L. Timed "Up & Go" test: reliability in older people dependent in activities of daily living-focus on cognitive state. Phys Ther 2006; 86: 646-655.
https://doi.org/10.1093/ptj/86.5.646
Martinez-Martin P, Rodriguez-Blazquez C, Alvarez-Sanchez M, Arakaki T, Bergareche-Yarza A, Chade A, et al. Expanded and independent validation of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). J Neurol 2013; 260: 228-236.
https://doi.org/10.1007/s00415-012-6624-1
Jonasson SB, Nilsson MH, Lexell J. Psychometric properties of the original and short versions of the Falls Efficacy Scale International (FES-I) in people with Parkinson's disease. Health Qual Life Outcomes 2017; 15: 1-8.
https://doi.org/10.1186/s12955-017-0689-6
Cervantes-Arriaga A, Rodríguez-Violante M. Validación de la versión en español del cuestionario de congelamiento de la marcha (FOG-Q) en enfermedad de Parkinson. Arch Neurocien 2011; 16: 173-178.
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-198.
https://doi.org/10.1016/0022-3956(75)90026-6
Hobert MA, Niebler R, Meyer SI, Brockmann K, Becker C, Huber H, et al. Poor trail making test performance is directly associated with altered dual task prioritization in the elderly - baseline results from the TREND study. PLoS One 2011; 6: 1-6.
https://doi.org/10.1371/journal.pone.0027831
Kamieniarz A, Michalska J, Brachman A, Pawłowski M, Słomka KJ, Juras G. A posturographic procedure assessing balance disorders in Parkinson's disease: a systematic review. Clin Interv Aging 2018; 13: 2301-2316.
https://doi.org/10.2147/CIA.S180894
Bouça-Machado R, Duarte GS, Patriarca M, Castro Caldas A, Alarcão J, Fernandes RM, et al. Measurement instruments to assess functional mobility in Parkinson's disease: a systematic review. Mov Disord Clin Pract 2020; 7: 129-139.
https://doi.org/10.1002/mdc3.12874
Onder H, Ozyurek O. The impact of distinct cognitive dual-tasks on gait in Parkinson's disease and the associations with the clinical features of Parkinson's disease. Neurol Sci 2020; 1-9.
https://doi.org/10.1007/s10072-020-04874-9
Hosmer DW, Lemeshow S, Sturdivant RX. Applied logistic regression. 3rd edn. New York: John Wiley & Sons; 2013.
https://doi.org/10.1002/9781118548387
Kelly VE, Eusterbrock AJ, Shumway-Cook A. A review of dual-task walking deficits in people with Parkinson's disease: motor and cognitive contributions, mechanisms, and clinical implications. Parkinsons Dis 2012; 2012: 1-14.
https://doi.org/10.1155/2012/671261
Spildooren J, Vercruysse S, Desloovere K, Vandenberghe W, Kerckhofs E, Nieuwboer A. Freezing of gait in Parkinson's disease: the impact of dual-tasking and turning. Mov Disord 2010; 25: 2563-2570.
https://doi.org/10.1002/mds.23327
Domingos JM, Godinho C, Dean J, Coelho M, Pinto A, Bloem BR, et al. Cognitive impairment in fall-related studies in Parkinson's disease. J Parkinsons Dis 2015; 5: 453-469.
https://doi.org/10.3233/JPD-150590
Chen TY, Peronto CL, Edwards JD. Cognitive function as a prospective predictor of falls. J Gerontol B Psychol Sci Soc Sci 2012; 67: 720-728.
https://doi.org/10.1093/geronb/gbs052
Morris S, Morris ME, Iansek R. Reliability of measurements obtained with the Timed "Up & Go" test in people with Parkinson disease. Phys Ther 2001; 81: 810-818.
https://doi.org/10.1093/ptj/81.2.810
Steffen T, Seney M. Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism. Phys Ther 2008; 88: 733-746.
https://doi.org/10.2522/ptj.20070214
Domholdt E. Physical therapy research: principles and application. Philadelphia, Pa: WB Saunders Co.; 2000.
Chen PH, Wang RL, Liou DJ, Shaw JS. Gait disorders in Parkinson's disease: assessment and management. Int J Gerontol 2013; 7: 189-193.
https://doi.org/10.1016/j.ijge.2013.03.005
Inkster LM, Eng JJ, MacIntyre DL, Stoessl AJ. Leg muscle strength is reduced in Parkinson's disease and relates to the ability to rise from a chair. Mov Disord 2003; 18: 157-162.
https://doi.org/10.1002/mds.10299
Kerr GK, Worringham CJ, Cole MH, Lacherez PF, Wood JM, Silburn PA. Predictors of future falls in Parkinson disease. Neurology 2010; 75: 116-124.
https://doi.org/10.1212/WNL.0b013e3181e7b688
Maetzler W, Hausdorff JM. Motor signs in the prodromal phase of Parkinson's disease. Mov Disord 2012; 27: 627-633.
https://doi.org/10.1002/mds.24973
Van Uem JMT, Walgaard S, Ainsworth E, Hasmann SE, Heger T, Nussbaum S, et al. Quantitative timed-up-and-go parameters in relation to cognitive parameters and health- related quality of life in mild-to-moderate Parkinson's disease. PLoS One 2016; 11: 1-15.
https://doi.org/10.1371/journal.pone.0151997
Tokushige SI, Terao Y, Matsuda S, Furubayashi T, Sasaki T, Inomata-Terada S, et al. Does the clock tick slower or faster in Parkinson's disease? Insights gained from the synchronized tapping task. Front Psychol 2018; 9: 1-12.
https://doi.org/10.3389/fpsyg.2018.01178
Sheehan KJ, O'Connell MDL, Cunningham C, Crosby L, Kenny RA. The relationship between increased body mass index and frailty on falls in community dwelling older adults. BMC Geriatr 2013; 13: 1-17.
https://doi.org/10.1186/1471-2318-13-132
Rahman S, Griffin HJ, Quinn NP, Jahanshahi M. On the nature of fear of falling in Parkinson's disease. Behav Neurol 2011; 24: 219-228.
https://doi.org/10.1155/2011/274539
Friedman SM, Munoz B, West SK, Rubin GS, Fried LP. Falls and fear of falling: Which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. J Am Geriatr Soc 2002; 50: 1329-1335.
https://doi.org/10.1046/j.1532-5415.2002.50352.x
Mak MKY, Pang MYC. Fear of falling is independently associated with recurrent falls in patients with Parkinson's disease: a 1-year prospective study. J Neurol 2009; 256: 1689-1695.
https://doi.org/10.1007/s00415-009-5184-5
Gervasoni E, Cattaneo D, Messina P, Casati E, Montesano A. Clinical and stabilometric measures predicting falls in Parkinson disease/parkinsonisms. Acta Neurol Scand 2015; 132: 235-241.
https://doi.org/10.1111/ane.12388
van der Marck MA, Klok MPC, Okun MS, Giladi N, Munneke M, Bloem BR, et al. Consensus-based clinical practice recommendations for the examination and management of falls in patients with Parkinson's disease. Parkinsonism Relat Disord 2014; 20: 360-369.
https://doi.org/10.1016/j.parkreldis.2013.10.030
Heremans E, Nieuwboer A, Spildooren J, Vandenbossche J, Deroost N, Soetens E, et al. Cognitive aspects of freezing of gait in Parkinson's disease: a challenge for rehabilitation. J Neural Transm 2013; 120: 543-557.
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