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BACKGROUND AND PURPOSE: Clinical correlates of fear of falling (FoF) are scarcely studied in patients with progressive supranuclear palsy (PSP) and multiple system atrophy (MSA). This study was undertaken to evaluate the clinical correlates of FoF in PSP and MSA. METHODS: This cross-sectional study features motor, cognitive, and psychiatric assessment and longitudinal evaluation of falls and FoF at 6-month follow-up. RESULTS: Twenty-one patients with PSP-parkinsonism, 22 patients with MSA (13 parkinsonian type and nine cerebellar type), and 22 healthy controls were evaluated; 76.2% of patients with PSP and 86.4% of patients with MSA had FoF regardless of falls. Berg Balance Scale (p < 0.001), Tinetti Mobility Test (p < 0.01), Beck Anxiety Inventory (p = 0.001), and Beck Depression Inventory-II (p = 0.01) correlated with FoF in patients with PSP and MSA, whereas Timed Up and Go test (p = 0.01) and Starkstein Apathy Scale correlated only in MSA (p = 0.04). CONCLUSIONS: Mobility, balance, and gait performance as well as anxiety and depression in PSP and MSA, and apathy in MSA, were determinants of FoF. These findings underline the importance of a multidisciplinary approach to FoF in neurodegenerative atypical parkinsonism.

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PURPOSE: Persons with Huntington's disease (HD) have a high incidence of falls. Autonomic nervous system dysfunction has been reported even in early stages of this disease. To date, there has been no analysis of the relationship between heart rate variability (HRV) and falls in this patient population. The aim of the study reported here was to evaluate the relationship between HRV and falls in persons with HD. METHODS: Huntington's disease patients enrolled in a prospective study on fear of falling and falls were assessed using short-term HRV analyses and blood pressure measures in both the resting and standing states. Time-frequency domains and nonlinear parameters were calculated. Data on falls, the risk of falling (RoF) and disease-specific scales were collected at baseline and at the end of the 6-month follow-up. RESULTS: Of the 24 HD patients who were invited to participate in the study, 20 completed the baseline analysis and 18 completed the 6-month follow-up. At baseline, seven (35%) HD patients reported at least one fall (single fallers) and 13 (65%) reported ≥ 2 falls (recurrent fallers) in the previous 12 months. At baseline, recurrent fallers had lower RMSSD (root mean square of successive RR interval differences) in the resting state (RMSSD-resting), higher LF/HF (low/high frequency) ratio in both states and higher DFA-α1 parameter (detrended fluctuation analyses over the short term) in both states. This association was similar at the 6-month follow-up for recurrent fallers, who showed lower RMSSD-resting and higher LF/HF ratio in the standing state (LF/HF-standing) than single fallers. Significant correlations were found between the number of falls, RMSSD-resting and LF/HF-standing. No differences were found between recurrent and single fallers for any blood pressure measures. CONCLUSIONS: The observed HRV pattern is consistent with a higher sympathetic prevalence associated with a higher RoF. Reduced parasympathetic HRV values in this patient population predict being a recurrent faller at 6 months of follow-up, independently of orthostatic phenomena.

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BACKGROUND: Fear of falling may be significantly associated with falls in Parkinson's disease (PD) and may have a negative impact on quality of life. Nevertheless, there are no valid and reliable tools to examine this condition in PD. The objective of this study was to design and determine the psychometric attributes of an instrument to assess fear of falling in PD. METHODS: A prospective 1-year, 2-phase study was conducted to validate the Fear of Falling Scale, a self-assessed instrument for assessing fear of falling in PD. During phase 1, we designed a scale to measure the severity of fear of falling and determine its baseline psychometric characteristics, whereas phase 2 was a 1-year follow-up study to assess the frequency of falls and other clinical factors linked to fear of falling. Convergent and discriminant validity were assessed against the Fear of Falling Measure and the Starkstein Apathy Scale, respectively. RESULTS: The Fear of Falling Scale showed high internal consistency, test-retest reliability, and strong convergent and discriminant validity. There was a significant association between fear of falling score and the presence of both generalized anxiety disorder and major depression, poor balance-related motor ability, increased nonmotor symptoms of PD, more severe impairments in activities of daily living, and increased motor fluctuations. Finally, generalized anxiety disorder was a significant predictor of number of falls during a 12-month follow-up period. CONCLUSIONS: The Fear of Falling Scale is a valid and reliable instrument to assess fear of falling in PD. Fear of falling in PD is associated with specific psychiatric and motor disorders and is significantly related to the performance of balance-related motor functions. © 2019 International Parkinson and Movement Disorder Society.

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Se realizó un estudio de casos y controles durante el año 2008 para identificar la relación causal de algunas variables de riesgo de cardiopatía isquémica en la población mayor de 15 años del Consejo Popular La Demajagua-Isla de la Juventud, Cuba. La muestra estuvo compuesta por 80 pacientes; de ellos, 40 casos con un equiparamiento por edad y sexo de 1:1. Se determinó que el sexo femenino, la edad de 51-59 años y el antecedente de diabetes mellitus y obesidad constituyeron factores de riesgo significativos en nuestra muestra de estudio, con un comportamiento diferente para la disminución del filtrado renal en la cual no se demostró una relación causal. La obesidad resultó ser el factor de riesgo de mayor significación en la aparición de la isquemia coronaria en la presente muestra, pues si pudiera ser eliminada o controlada se podría disminuir la incidencia de la enfermedad en alrededor del 35 porciento

A case-control study was conducted throughout the year 2008 to identify the causal role of some ischemic heart disease risk factors in adults aged over 15 from La Demajagua People's Council on the Isle of Youth, Cuba. The sample was composed of 80 patients, of whom 40 were 1:1 paired for age and sex. Female sex, the 51-59 age range and a history of diabetes mellitus and obesity were found to be significant risk factors in the study sample, unlike reduced renal filtration, for which a causal relationship was not found. Obesity was the most significant coronary ischemia risk factor in the study group. The incidence of the disease would be reduced in about 35 percent if this risk factor could be either eliminated or controlled

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Las enfermedades cardiovasculares (ECV) son las principales causas de muerte en los pacientes de mediana edad y de edad avanzada en la mayoría de los países desarrollados y en muchos en desarrollo; de ellas, la más frecuente es la enfermedad coronaria (EC). Se realizó un estudio de casos y controles durante el año 2008 para identificar la relación causal de algunas variables de riesgo de cardiopatía isquémica en la población mayor de 15 años del Consejo Popular "La Demajagua", de Isla de la Juventud, Cuba. La muestra estuvo compuesta por 80 pacientes; de ellos, 40 casos con un equiparamiento por edad y sexo de 1:1. Se determinó que el sexo femenino, la edad de 51-59 años, el antecedente de tabaquismo, la hipertensión arterial o las dislipidemias constituyeron factores de riesgo significativos de cardiopatía isquémica. La hipertensión arterial resultó el factor de riesgo de mayor significación en la aparición de la isquemia coronaria. Existió una relación directa entre el nivel de consumo de cigarrillos diarios y el riesgo coronario. De acuerdo con nuestros resultados, fue 17 veces mayor el riesgo en los fumadores pesados que en los no fumadores. Si se logra controlar o eliminar la presencia de la hipertensión arterial se disminuye el riesgo en la aparición de la cardiopatía isquémica.

The cardiovascular diseases (CVD) are the main causes of death in mean and advanced age patients in most of developed countries and in many developing ones; from them the more frequent is the coronary disease (CD). A case/control study was conducted in 2008 to identify the causal relation of some of ischemic heart disease risk variables in a population aged over 15 from the "La Demajagua" Popular Council of Isla de la Juventud province, Cuba. Sample included 80 patients; from them 40 cases with a ratio of 1:1 by age and sex. It was determined that the female sex, age from 51 to 59 years, the history of smoking, the high blood pressure or the dyslipidemias were the more significant risk factors in appearance of coronary ischemia. There was a direct relation between the daily cigarette consumption level and the coronary risk. According to our results the risk in heavy consumers was greater than in those non-smokers. If is possible to achieve the control or eradication of high blood pressure, the risk of appearance of ischemic heart disease disappear.