People Understand Risk of Falling, But Not the Risk Factors

For older people, and especially those with Parkinson’s, a fall-related injury is the first event in a chain that leads to ever-worsening problems. I’d say it’s probably the best indicator of how advanced a person’s progression is: the cane, the walker, the wheelchair, and the ability to negotiate even a door jamb or threshold.

A paper in the Journal of Neuroscience Nursing (reprinted at Medscape) describes interviews with 28 people with Parkinson’s. Nearly all of them knew that they were at higher risk for falling. However, many did not understand the factors that might lead to falling, especially the risk posed by medication:

Although our cohort recognized that their probability of falling was substantial, they lacked awareness of specific risk
factors for falling, particularly those associated with medication use. This was a surprising finding, considering that the participants enrolled in this study were taking numerous medications, and many of those medications are known to increase risk for falling. The fact that these individuals attended a movement disorder clinic led us to hypothesize that
their awareness of all risk factors would have been much higher. 

Maybe it’s simple denial, a willful whistle past the graveyard, or maybe there’s some pathological blind spot that leaves those of us with PD in ignorance of even the obvious. Hopefully our friends and partners are more aware of these problems, and are willing to look out for us.

Symposium Videos Now Available Via DHMC

I’m amazed at how efficient Diane and her colleagues at DHMC have become at communications. Video from the sessions at last month’s Parkinson’s Awareness Day symposium is now available, online and on DVD.

Point your browser to www.dhmc.org/goto/parkinson, then click “Events” on the left side of that page. You’ll see links to the presentation by Dr. David Roberts on deep-brain stimulation surgery; the panel discussion that followed; and Dr. Steven Lee’s presentation on cutting-edge research. You’ll need a high-speed network connection to view these files; or you can get the DVD. Enjoy!

Sleep Disorder as an Early Indicator of Parkinson’s

Researchers are still looking for ways to identify Parkinson’s and other neurodegenerative diseases before the physical symptoms become obvious. Recent attention has been on problems with smell — that a standard doctor’s office smell test can be a remarkably effective predictor of Parkinson’s. That, in turn, might allow doctors to prescribe substances that have a protective effect.

Researchers at the Mayo Clinic (including Dr. Bradley Boeve, who I’ve had the pleasure of meeting) are know looking at whether certain types of sleep disorders are associated with developing dementias, such as Parkinson’s. The studies (press releases at mayo.org) focused on REM sleep behavior disorder (RBD), a condition where people act out events in their dreams, sometimes violently.
RBD has long been anecdotally associated with Parkinson’s. These studies were apparently the first to examine this proposition in a larger population-based method. The studies determined that other neurological problems, such as cognitive decline, anxiety, apathy, and Parkinsonism, were statistically more likely to happen in people with RBD than in the general population. 
More study is definitely in order, especially regarding the co-incidence of Parkinsonism. But it does make me wonder if the cognitive problems are simply a result of poor quality sleep. I look forward to hearing more about it.