Focus on Falls in Parkinson’s and Cognitive Impairment

By Prof Stephen Lord

Falls are a major problem in the senior community with 1 in 3 people aged 65+ falling at least once a year and this risk increases as they age. This rate almost doubles for seniors living with Parkinson’s disease and cognitive impairment (60%), making falls the leading cause of injury-related disability and death in this age bracket.

There are many risk factors for falls including environmental hazards, poor footwear and certain medications. Physical, psychosocial and medical conditions like muscle weakness, impaired balance, depression and inactivity also create a significant risk factor and these aspects are prevalent in people with Parkinson’s disease or Cognitive Impairment.

The symptoms associated with Cognitive Impairment and Parkinson’s Disease put patients at a much higher risk of falling:

 Cognitive Impairment

  • Reduced strength and power
  • Slower reaction time
  • Increased body sway
  • Poorer controlled leaning balance
  • Less smooth walking rhythm
  • Impulsivity
  • Depression

 Parkinson’s Disease

  • Reduced strength and power
  • More episodes of freezing
  • More stooped posture
  • Slower reaction time
  • Impaired cognition – executive functioning
  • Reduced maximum balance range
  • Poorer controlled leaning balance
  • Less smooth walking rhythm

These findings naturally lead to the question – how can we prevent these fall related injuries?

Exercise interventions have been successful in reducing the number of falls in these vulnerable groups, with studies showing a 45% reduction in Cognitive Impairment patients and a 53% reduction for Parkinson’s patients. The exercises for Cognitive Impairment sufferers consisted of endurance, balance, and strength training and were performed for 1 hour, twice a week for 12 months. Parkinson’s sufferers were given Movement Strategy Training and Resistance Training which used strategies such as mental rehearsal, visual cues, rhythmic cues and weighted vests.

Fall prevention for Parkinson’s patients may also be aided by medication. A loss of cholinergic function is a significant contributing factor to freezing and other gait changes, postural inability and cognitive dysfunction. Promising findings also suggest that a medication that reduces the breakdown of acetylcholine (an important brain chemical for both cognition and movement), may promote a smooth and consistent walking with resulting fewer falls.

As research into the problem continues, evidence is suggesting that high-level balance exercises are one of the most effective methods of fall prevention. Many other methods are also proving to be beneficial like voluntary and reactive step training, occupational therapy interventions and maintaining healthy eyesight.

Parkinsons fallsIMG_4931

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