Impaired Executive Function Can Predict Recurrent Falls in Parkinson's Disease

ObjectiveTo examine whether impairment in executive function independently predicts recurrent falls in people with Parkinson's disease (PD).DesignProspective cohort study.SettingUniversity motor control research laboratory.ParticipantsA convenience sample of community-dwelling people with PD (N=144) was recruited from a patient self-help group and movement disorders clinics.InterventionsNot applicable.Main Outcome MeasuresExecutive function was assessed with the Mattis Dementia Rating Scale Initiation/Perseveration (MDRS-IP) subtest, and fear of falling (FoF) with the Activities-specific Balance Confidence (ABC) Scale. All participants were followed up for 12 months to record the number of monthly fall events.ResultsForty-two people with PD had at least 2 falls during the follow-up period and were classified as recurrent fallers. After accounting for demographic variables and fall history (P=.001), multiple logistic regression analysis showed that the ABC scores (P=.014) and MDRS-IP scores (P=.006) were significantly associated with future recurrent falls among people with PD. The overall accuracy of the prediction was 85.9%. With the use of the significant predictors identified in multiple logistic regression analysis, a prediction model determined by the logistic function was generated: Z = 1.544 + .378 (fall history) − .045 (ABC) − .145 (MDRS-IP).ConclusionsImpaired executive function is a significant predictor of future recurrent falls in people with PD. Participants with executive dysfunction and greater FoF at baseline had a significantly greater risk of sustaining a recurrent fall within the subsequent 12 months.     

Alternative scoring for Physical Activity Scale for the Elderly (PASE)

Background

Studies assessing physical functioning with the Physical Activity Scale for the Elderly (PASE) should be aware that the instrument may be age and culture insensitive.

Objectives

To asses “classical” PASE scoring in a sample of aged (mean age 74) Mexican origin Latinos in the Southwestern United States and provide a new scoring algorithm.

Method

Information from a cross sectional study of 2438 community-dwelling minority subjects who completed the PASE scale was scored with the classical and a new scoring approach to compare their similarity and predictive power on three items of functional ability.

Results

The classical and new scoring procedures for PASE items render different total scores.

Conclusion

The classical approach for scoring PASE in aged minorities may fail to capture the age and culture insensitivity of the instrument. The new approach, or a derivation of it, should be used to compute the total PASE score for minority aged populations as further research continues.     

Cardiorespiratory fitness and its association with body composition and physical activity in Hong Kong Chinese women aged from 55 to 94 years

Background

Low levels of cardiorespiratory fitness have proven to be associated with a higher risk of premature death from all causes, specifically from cardiovascular disease. However, there has been no study conducted to describe the cardiorespiratory fitness normative values in Chinese midlife and elderly.

Objectives

To provide normative values of cardiorespiratory fitness expressed as maximal oxygen uptake (VO_2max) and its association with body composition and physical activity in Chinese midlife and elderly women in Hong Kong.

Methods

659 Chinese women aged from 55 to 94 years were recruited from two existing cohorts: the carotid atherosclerosis in women Hong Kong cohort study and the Osteoporotic Fractures in Women (MsOS) Hong Kong cohort study. Symptom-limited maximal exercise testing on an electrically braked bicycle ergometer was performed to assess VO_2max, where the subject was connected to a calibrated metabolic cart for gas analysis. Their body composition and physical activity data were also assessed.

Results

The body mass index was 23.4 kg/m² and the mean fat mass and lean body mass were 16.6 kg and 37.3 kg, respectively. The mean VO_2max was 20.3 ± 4.1 ml/kg/min (range, 7.9–35.7 ml/kg/min). VO_2max decreased with age, with the rate of decline 0.25 ml/kg/min/yr (7.1% per decade). In a subgroup of 475 women from the MsOS study, the decline in VO_2max was found to depend on ageing (β = 0.31, P < 0.001), body mass index (β = −0.30, P < 0.001) and levels of physical activity (β = 0.02, P < 0.001). Fat mass was also independently associated with VO_2max (β = −0.20, P < 0.001).

Conclusions

This study describes the normative values of VO_2max in a sample of Chinese midlife and elderly women which provides a valuable reference to assess health and fitness in Chinese elderly. Results from this study also suggested that body composition and levels of physical activity were important determinants of the age-related decline in VO_2max.     

Longitudinal Physical Activity Changes in Older Men in the Osteoporotic Fractures in Men Study

OBJECTIVES: To describe the change in physical activity (total, leisure, household, occupational) in men over a mean 5‐year follow‐up period and to identify sociodemographic and health factors associated with change in physical activity. DESIGN: Prospective cohort study; Osteoporotic Fractures in Men Study; data collected March 2000 through May 2006. SETTING: Six U.S. clinical centers. PARTICIPANTS: Volunteer sample of ambulatory community‐dwelling men aged 65 and older (N=5,161). MEASUREMENTS: Self‐reported physical activity assessed at baseline and Visit 2 (V2) (5 years apart) according to the Physical Activity Scale for the Elderly (PASE) (unitless, relative measure of physical activity). RESULTS: At baseline, PASE scores averaged 16.8±35.5 for occupational, 37.0±34.0 for leisure, 95.9±43.2 for household, and 149.7±67.6 for total physical activity. Occupational (?6.2±33.9), leisure (?3.2±37.3), household (?9.9±44.3), and total (?19.3±67.7) physical activity change scores declined, on average, from baseline to V2. On average, change in total PASE scores declined more with age: ?15.6±71.6 for men younger than 70, ?16.4±67.0 for men aged 70 to 74, ?21.4±66.9 for men aged 75 to 79, and ?29.5±60.7 for men aged 80 and older. Living alone, smoking cigarettes, poor health, and higher blood pressure were associated with greater declines in physical activity over time. Although average scores declined, some older men (1,335, 26%) reported increasing physical activity levels. Better physical and mental health, living with others, and being younger were associated with the probability of increasing physical activity over time. CONCLUSION: Over the 5‐year period, the majority of men reported declines in total physical activity. Older men in poor health who live alone have a high risk of physical activity declines and may be an important group to target for exercise interventions.