Parkinson Hastalığında Tekrarlayan Düsmeler Önceden Tahmin Edilebilir mi?

Amaç: Hareket Bozuklukları Polikliniğinde takip edilen hastaların tekrarlayan düsme sıklığını, tekrarlayan düsmesi olan hastaların demografik ve klinik özelliklerini, son olarak da denge değerlendirmesinin prospektif olarak 1 yıllık süre içerisinde düsme tahmini için göreceli doğruluğunu arastırmaktır. Gereç ve Yöntem: Hareket Bozuklukları Polikliniğine ardısık olarak basvuran idiyopatik Parkinson hastalığı olan hastalar çalısmaya dahil edildi. Hastaların demografik verileri ve hastalık özellikleri kaydedildi. Dengenin değerlendirilmesi için Berg Denge Ölçeği, Fonksiyonel Öne Uzanma Testi, 5 Kere Otur ve Kalk Testi ile Süreli Kalk ve Yürü Testi kullanıldı. Takiben hastalardan ve/veya yakınlarından prospektif olarak 1 yıl süreyle düsme günlüğü tutulması istendi. Bulgular: Bir yıl sonra 102 hastanın 47'sinde (%46,1) en az bir kere, 35'inde (%34,3) ise tekrarlayan düsme tespit edildi. Tekrarlayan düsmesi olanlar daha uzun hastalık süresi ve levodopa dozları daha fazla olan, Hoehn &Yahr evrelemesi ve Birlesik Parkinson Hastalığı Değerlendirme Ölçeğine göre hastalık siddeti artmıs hastalardı. Aynı zamanda bu hastalar Fonksiyonel Uzanma Testinde, Süreli Kalk ve Yürü Testinde ve 5 Kere Otur ve Kalk Testinde daha kötü skorlar elde etti ve Berg Denge Ölçeğinde daha düsük puanlar elde ettiler. Alıcı İsletim Karakteristliği analizi sonuçlarına göre Fonksiyonel Uzanma Testi, düsmeleri öngören en yüksek sensitivite ve spesivite kombinasyonunu sağladı. Bunu sırasıyla Berg Denge Ölçeği, Süreli Kalk ve Yürü testi ve 5 Kere Otur ve Kalk testi izledi. Sonuç: Parkinson hastalığı olan hastaların yaklasık üçte birinde tekrarlayan düsmelere rastlanmaktadır. Hastalığın ilerlemesinin düsmeler üzerine olumsuz etkisi bulunmaktadır. Düsme riskini öngörmede en uygun test Fonksiyonel Uzanma Testi olmakla birlikte, Berg Denge Ölçeği, Süreli Kalk ve Yürü Testi ve 5 Kere Otur ve Kalk Testinin de düsme riskini tahmin etmede faydalı olabileceği gösterilmistir. Düsme riskinin öngörülmesi, komplikasyonların önlenmesi yoluyla yasam kalitesini olumlu yönde etkileyebilir.

Can Recurrent Falls be Predicted in Parkinson's Disease?

Objective: This study aims to investigate the prevalence of recurrent falls in patients who are being followed up in Movement Disorder Outpatient Clinic, demographic and clinical characteristics of patients with recurrent falls, and relative accuracy of balance assessment for prediction of falls prospectively within 1 year. Materials and Methods: The patients who were admitted to Movement Disorder Outpatient Clinic due to idiopathic Parkinson's disease were consecutively included in the study. Demographic data and disease characteristics of the patients were recorded. Berg Balance Scale, Functional Reach Test, Five Times Sit-To-Stand Test and Timed Up and Go Test were used for assessment of balance. Subsequently, the patients and/or their relatives were asked to fill out fall diaries for 1 year. Results: At the end of one year, at least one fall was detected in 47 (46.1%) and recurrent falls were detected in 35 (34.3%) out of 102 patients. The patients who had recurrent falls had a longer duration of disease, were using higher doses of levodopa and had higher disease severity according to Hoehn &Yahr staging and Unified Parkinson's Disease Rating Scale. These patients obtained lower scores in Functional Reach Test, Five Times Sit-To-Stand Test, Timed Up and Go Test and Berg Balance Scale. According to Receiver Operating Characteristic analysis, Functional Reach Test had maximum specificity and sensitivity for prediction of falls followed by Berg Balance Scale, Timed Up and Go Test and Five Times Sit-To-Stand Test. Conclusion: Recurrent falls have been found in approximately one-third of the patients with Parkinson's disease. Disease progression had a negative effect on falls. While the Functional Reach Test is the most appropriate test for prediction of fall risk, Berg Balance Scale, Timed Up and Go Test and Five Times Sit-To-Stand Test were also shown to be useful. Prediction of fall risk may positively influence quality of life through preventing complications.

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