Cardiovascular Autonomic Neuropathy Raises Fall Risk in Parkinson Disease

Fall Risk
Fall Risk
Cardiovascular autonomic neuropathy, including but not limited to orthostatic hypotension, is a strong, independent predictor of falls in Parkinson disease.

Cardiovascular autonomic neuropathy increases the risk for falling by 15-fold for people with Parkinson disease, according to a prospective study published in the Journal of Neurology.1

Researchers assessed 50 people with Parkinson disease using clinical and autonomic evaluations at baseline, 6 months, and 12 months. Clinical evaluations consisted of tests monitoring dysfunctional motor severity, postural stability, mobility, gait, freezing episodes, and cognition. Autonomic evaluations consisted of heart rate variability and blood pressure during breathing exercises and blood pressure challenges. Records of falls, dopaminergic medication, dyskinesia severity, and disrupted sleep were also assessed.

Of the 50 participants, 68% were men, mean age was 65.06 years old, and the average disease duration was 8.23 years. At baseline, 19 participants had cardiovascular autonomic neuropathy, 17 participants had orthostatic hypotension, and 18 participants had a fall in the previous 6 months.

During the 12-month follow-up, 28 participants reported falling at least once. After adjusting for covariates, the odds ratio (OR) for falling and having cardiovascular autonomic neuropathy was 15.194 (95% CI, 2.288-34.205; P =.011), and falling and having orthostatic hypotension was 10.702 (95% CI, 1.455-29.270; P =.02). These data were confirmed after excluding those participants who had a history of falls at baseline.

Researchers also found an association between falls and a history of falls (OR 15.549; 95% CI, 2.058–36.571; P =.017), postural instability (OR 14.021; 95% CI, 1.521–35.526; =.017), REM sleep behavioral disorder (OR 5.470; 95% CI, 1.133–26.410; P =.034), and freezing of gait (OR 1.450; 95% CI, 1.050–2.151; P =.044). Again, these data were confirmed after excluding those participants who had a history of falls at baseline.

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Results showed that a positive history of falls is an independent predictor of future falls. Moreover, researchers noted that this study is the first one to provide “evidence that [REM sleep behavioral disorder] is an independent predictor of falls” highlighting “the intimate connection between sleep dysfunction, dysautonomia, and postural instability” observed in a previous paper.2

Future research needs to increase sample size to increase statistical power, assess the causes of the falls, utilize polysomnographic confirmation for REM sleep behavioral disorder, and evaluate whether early treatments could reduce falls in people with cardiovascular autonomic neuropathy.

The researchers concluded that cardiovascular autonomic neuropathy is independently associated in an increased risk for falls in people with Parkinson disease and “deserves clinical attention and appropriate therapeutic management.”

Disclosures: Multiple authors declare affiliations with the pharmaceutical industry. Please refer to reference for a complete list of authors’ disclosures.


  1. Romagnolo A, Zibetti M, Merola A, et al. Cardiovascular autonomic neuropathy and falls in Parkinson disease: a prospective cohort study [published online October 31, 2018]. J Neurol. doi: 10.1007/s00415-018-9104-4
  2. Romenets SRGagnon JFLatreille V, et al. Rapid eye movement sleep behavior disorder and subtypes of Parkinson’s disease. Mov Disord. 2012;27(8):996-1003. doi: 10.1002/mds.25086.