Frailty and risk for falling in Parkinson’s disease. A longitudinal, randomized, multidisciplinary-based telemedicine intervention

Abstract

Objective: To investigate the relationship between frailty and risk of falling in Parkinson’s disease (PD).

Background: Frailty can lead to increased vulnerability in patients with PD and worsen their health conditions. The prevalence and association of motor and non-motor symptoms (NMS) and other non-related PD factors with the risk of falling and frailty are still controversial.

Methods: This is a single-center, longitudinal, two group randomized study (NCT04694443). We recruited a cohort of non-demented PD patients with falls over the last 6 months. We conducted baseline, 4-months, and 8-months multidisciplinary evaluations. PD patients were randomized to receive in-office assessments versus alternating televisits including weekly Occupational Therapy sessions and monthly nurse and neurologist visits. The severity of motor symptoms was evaluated using the MDS-Unified Parkinson’s Disease Rating Scale (NMS-UPDRS) and Hoehn Yahr stage; NMS with the Non-Motor Symptoms Scale (NMSS), depression and anxiety with Beck BDI-II, apathy with Lille rating scale (LARS); frailty with FRAIL rating scale and Fried criteria, comorbidity with Geriatric CIRS-G, dysphagia with EAT10, quality of life with EUROHIS-QOL 8, and gait/balance with Mini-BESTest. Comparative and correlation analyses were conducted to analyze these associations.

Results: 41 PD patients were included, 20 males (48.8%) and 21 females (51.2%), with a median number of falls in the last month of 1 (range 0 to 20), mean MDS-UPDRS part III score of 40.17 ± 10.86, and frailty FRAIL and Fried scores of 1.10 ± 1.37, and 1.41 ± 1.36, respectively. Frailty (Fried criteria) was associated with age (r=0.34, p=0.03). FRAIL scores had a high correlation with FOGQ (r=0.67, p=0.0001), PDQ (r=0.66, p=0.0001), and MDS-UPDRS (r=0.62, p=0.0001), a moderate correlation with Mini-BESTest (r=-0.59, p=0.0001), EUROHIS-QOL 8 (r=-0.51, p=0.001), NMSS (r=0.43, p=0.005), CIRS-G (r=0.41, p=0.007), and BDI-II (r=0.40, p=0.010), and a low correlation with LARS (r=0.36, p=0.02), and EAT10 (r=0.31, p=0.04). There was a trend with Body Mass Index (r=0.27, p=0.08), and number of falls (r=0.25, p=0.11).

Conclusions: Frailty is associated with adverse health outcomes and increases the risk of falling in PD. Multidisciplinary telemedicine adjuvant interventions can improve access to vulnerable PD populations to prevent disability and dependence.

José Luis Garrido-Labrador

Assistant Lecturer in Computer Languages and Systems

PhD in Machine Learning, researching in semi-supervised learning and restricted set classification. Assistant Lecturer in Computer Languages and Systems at Universidad de Burgos.