Objective: To identify cognitive and psychological factors contributing to balance discordance in people with Parkinson’s disease (PwPD) and examine how it is associated with fear of falling avoidance behavior (FFAB), with the goal of understanding how balance discordance influences participation in daily activities.

Background: Balance discordance, the mismatch between actual and perceived balance, is associated with fall history in PwPD [1]. However, its neurobehavioral contributors and its relationship with FFAB remain unclear.

Method: Data from 39 PwPD were collected, including demographics (age, sex), disease severity (disease duration, Hoehn & Yahr Scale, Movement Disorder Society – Unified Parkinson’s Disease Rating Scale Part 3 (MDS-UPDRSIII)), and balance discordance. Cognitive and neurobehavioral symptoms were quantified using: Trail Making Test (TMT) Parts A and B, Geriatric Depression Scale (GDS), Symbol Digit Modalities Test (SDMT), Parkinson Anxiety Scale (PAS), and cognitive-motor dual-task (DT) measures (calculated from the Timed Up and Go (TUG) and DT-TUG)). FFAB was quantified using the modified FFAB Questionnaire (mFFABQ). Lasso regression identified the neurobehavioral factors contributing to discordance, and hierarchical linear regression determined how discordance, independent of age, sex, and disease severity, explained variance in FFAB.

Results: The final lasso model, including neurobehavioral contributors to discordance, explained 47.2% of the variance (p<0.001) in discordance. The model included the following variables: DT-TUG time (β=-0.51), disease duration (β=-0.03), MDS-UPDRSIII (β=-0.24), persistent anxiety (PAS-A) (β=-1.41), and SDMT correct responses (β=0.11). In the model examining balance discordance’s relation to FFAB, adding discordance improved fit (ΔR² = 0.51, p < 0.0001). Discordance was a significant negative predictor of mFFABQ (β = -0.43, p < 0.0001).

Conclusion: These findings highlight the influence of anxiety and cognition on balance discordance in PwPD. Increased DT-TUG time, higher persistent anxiety, and poorer SDMT performance were linked to more negative discordance, or “under-confidence” in one’s balance ability. Discordance was also a key predictor of FFAB, with PwPD who are under-confident in their balance abilities less likely to engage in daily activities due to fear of falling.

References: [1] Longhurst JK, Hooyman A, Landers MR, et al. Discordance Between Balance Ability and Perception Is Associated With Falls in Parkinson’s Disease: A Coordinated Analysis. Neurorehabilitation and Neural Repair. 2024;39(2):114-125. doi:10.1177/15459683241300456

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MDS Abstracts - https://www.mdsabstracts.org/abstract/factors-contributing-to-balance-discordance-and-its-impact-on-fear-of-falling-avoidance-behavior-in-parkinsons-disease/