Impaired set shifting is associated with previous falls in individuals with and without Parkinson's disease

Abstract

Background: Individuals with Parkinson's disease (PD) are at increased risk for falls, which lead to substantial morbidity and mortality. Understanding the motor and non-motor impairments associated with falls in PD is critical to informing prevention strategies. In addition to motor symptoms, individuals with PD exhibit non-motor deficits, including impaired set shifting, an aspect of executive function related to cognitive flexibility that can be measured quickly with the Trailmaking Test.

Research question: To determine whether impaired set shifting is associated with fall history in people with and without PD.

Methods: We examined associations between set shifting, PD status, and fall history (≥1 falls in the previous 6 months) in data from PD patients (n = 65) with and without freezing of gait (FOG) and community-dwelling neurologically-normal older adults (NON-PD) (n = 73) who had participated in our rehabilitation studies.

Results: Impaired set shifting was associated with previous falls after controlling for age, sex, overall cognitive function, PD status, FOG, and PD disease duration (OR = 1.29 [1.03-1.60]; P = 0.02). Consistent with literature, PD and FOG were also independently associated with increased fall prevalence (PD OR = 4.15 [95% CI 1.65-10.44], P < 0.01; FOG OR = 3.63 [1.22-10.80], P = 0.02). Although the strongest associations between set shifting and falling were observed among PD without FOG (OR = 2.11) compared to HOA (OR = 1.14) and PD with FOG (OR = 1.46), no statistically-significant differences were observed across groups.

Significance: Impaired set shifting is associated with previous falls in older adults with and without PD. Set shifting may be useful to include in fall risk assessments, particularly when global cognitive measures are within reference limits.

Keywords: Balance; Executive function; FOG; Freezing of gait; Frontostriatal.