パーキンソン病の転倒リスクとその対応

Fall Risk and Its Management in Parkinson's Disease

パーキンソン病患者は通常の高齢者に比べ転倒リスクが高く，発症前から認められる症状の1つである。転倒は骨折やADL低下，認知機能障害を介し予後に影響する。歩行障害の要因として，すくみ足や体幹のバランス異常などの運動障害のみならず，起立性低血圧，認知障害など多岐にわたる。さらに家屋の配置や段差などの環境因子も関与する。そのため，多職種連携での評価と予防が重要である。

Abstract

Falls represent critical clinical events in older people, leading to functional decline, fractures, and deterioration in their ability to perform activities of daily living and decreased cognitive abilities, resulting in a bedridden state. Progression of Parkinson's disease (PD) causes postural instability, gait disturbances, gait freezing, and cognitive dysfunction, which markedly elevate the risk of falling compared with that of the general older adult population. Kempster et al. revealed that patients with PD frequently fall, reaching major milestones in PD such as dementia or institutionalization within only a few years; therefore, falls directly influence the prognosis of those with PD. In addition, falls in those with PD are related to not only motor dysfunction but also nonmotor features, including orthostatic hypotension and cognitive decline. Age-related sarcopenia, comorbidities, polypharmacy, and environmental factors further increase the risk of falls; as such, these underlying factors must be understood, and targeted preventive strategies must be implemented for patient management.