Objective: To evaluate the clinical correlates of fear of falling (FoF) in patients with Progressive Supranuclear Palsy (PSP) and Multiple System Atrophy (MSA)

Background: FoF leads to avoidance behaviors, functional decline, restriction of social participation, and an increased risk of falling and institutionalization; (1) FoF  has also been associated with worst balance, recurrent falls, anxiety (2) and cognitive impairment(3). However, in atypical parkinsonisms like PSP and MSA, cognitive and psychiatric correlates to FoF remain understudied

Method: Patients with PSP and MSA were evaluated at baseline and at 6 months follow up with a daily falls diary. FoF was assessed with the International Falls Efficacy Scale (FES-I), and FoF was defined as FES-I > 28.  Recurrent falls were defined as 2 or more falls in the follow up. Balance and Gait, Cognitive and  Psychiatric scales were also administered

Results: 21 patients with PSP and 22 with MSA were included; There were no significant differences in sex, age, and disease duration. At baseline  we found similar recurrent falls (in the last year), FoF scores, balance and gait functionality scales between PSP and MSA but  worse than in control.  At 6 months follow up, PSP patients had a higher number of falls than MSA patients (median 5 vs 2.5 p= <0.001). FoF was found in 76,2% of PSP and 86,4% MSA (p=0.3).  FoF was not associated with recurrent falls (PSP p=0.12; MSA p= 0.5), but with  worse balance, lower gait scores and  anxiety in both PSP and MSA ( p=0.018 and 0.001). However, worse executive function was only  associated with FoF  in MSA (Phonological verbal fluency p=0.048;  Frontal Assessment Battery  p=0.037). Interestingly, worse cognitive and depression scores were found in Fearful non-Fallers, compared to  Fearless non-Fallers. In addition worse cognitive , depression and apathy was found in Fearless Fallers  compared to Fearless Non-fallers.

Conclusion: Fear of falling was associated with poorer balance, gait functionality and anxiety in both conditions PSP and MSA.   Mood and Cognition independently of balance and gait performance,  might contribute to development of FOF or  the lack of FOF non congruent with patient falls

References: 1. Cumming RG, Salkeld G, Thomas M, Szonyi G. Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission. J Gerontol A Biol Sci Med Sci. 2000 May;55(5):M299-305. doi: 10.1093/gerona/55.5.m299. PMID: 10819321.
2. Ghielen I, Koene P, Twisk JW, Kwakkel G, van den Heuvel OA, van Wegen EE. The association between freezing of gait, fear of falling and anxiety in Parkinson’s disease: a longitudinal analysis. Neurodegener Dis Manag. 2020 Jun;10(3):159-168. doi: 10.2217/nmt-2019-0028. Epub 2020 Jun 17. PMID: 32552383.
3. Chomiak T, Watts A, Burt J, Camicioli R, Tan SN, McKeown MJ, Hu B. Differentiating cognitive or motor dimensions associated with the perception of fall-related self-efficacy in Parkinson’s disease. NPJ Parkinsons Dis. 2018 Aug 20;4:26. doi: 10.1038/s41531-018-0059-z. PMID: 30155514; PMCID: PMC6102294.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cognitive-and-psychiatric-correlates-of-fear-of-falling-in-progressive-supranuclear-palsy-and-multiple-system-atrophy/