Objective: Objective: To examine if balance confidence, measured by the Activities-specific Balance Confidence (ABC) scale, reflects fall frequency in atypical parkinsonian syndromes (APS), namely multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal syndrome (CBS), over the past month.

Background: Background: The ABC is a validated measure of balance confidence and fall predictor in Parkinson’s disease. While sharing symptoms with Parkinson’s, APS have more severe postural instability, executive impairment, and frequent falls. Knowledge about the use of subjective balance measures like the ABC in APS is limited but needed to inform treatment. Given APS’s rapid progression and unique cognitive profiles, we hypothesize that balance confidence does not correlate with fall risk in APS.

Method: 78 people with APS (38 PSP, 30 MSA, 10 CBS) seen at the UNC Atypical Parkinsonism Interdisciplinary Clinic between 2018-2024 completed the ABC at their appointment. Fall frequency in the past month was based on reports to the treating neurologist and physical therapist. Linear regression was used to determine whether balance confidence reflects fall frequency controlling for age. Secondary analyses explored cognitive symptoms, measured by the Montreal Cognitive Assessment (MoCA), and diagnosis as modifiers of this relationship.

Results: This cohort had a mean ABC score of 34.10 (SD = 24.16) and mean of 2 falls/past month (SD = 4.04). When controlling for age, ABC did not predict fall frequency (𝛽 = 0.0089, p = 0.6590). Though a diagnosis of PSP or CBS associated with higher fall frequency compared to MSA (𝛽 = 2.01, p = 0.0027), diagnosis did not act as an effect measure modifier (𝛽 = 1.10, 𝑝 = 0.644) in the relationship between ABC and falls frequency, after removing 2 MSA outliers with high fall frequency. MoCA scores did not predict fall frequency, nor did it influence the relationship between ABC and falls.

Conclusion: Balance confidence, assessed by the ABC scale, did not correlate with fall frequency in APS in our cohort. Although this study is limited to self-report and retrospective data, clinicians should be aware that balance confidence alone may not capture current fall risk and should use additional measures of fall risk. Future studies should utilize a longitudinal cohort and include additional measures of executive function and safety awareness which may mediate this relationship in our findings.

« Back to 2025 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/balance-confidence-may-not-accurately-assess-fall-risk-in-atypical-parkinsonism/