Abstract

Background: Parkinson’s Disease (PD) is a postmortem diagnosis but antemortem presence of tremor, stiffness or rigidity, bradykinesia, hypokinesia, balance problems and/or gait disorders provides clinical syndromic diagnosis of PD. This paper explains why people with PD often present with falls, with previously undiagnosed PD.
Why patients with PD have unexplained falls: People with PD have rigidity, hypokinesia and bradykinesia causing falls, often labelled as “unexplained”. When non-Parkinsonian people lose balance, they spread their centre of gravity. Those with PD cannot act as quickly leading to falls before evoking the righting reflexes.
Clinical experience: Suggesting unexplained falls are due to PD often evokes scepticism from younger trainees who fail to adopt distraction when examining increased resting tone. Failure to swing the ipsilateral arm when walking is often missed. A positive glabella tap is often not tested. Other features, including primitive reflexes, such as palmar mental responses and grasp reflexes, help to diagnose PD. It has long been the practice of the author to start anti-Parkinsonian pharmacological treatment, with levodopa early, as soon as the clinical diagnosis has been made.
Conclusion: Falls in the elderly are often considered “unexplained” because the clinical examination was less than optimal. PD remains a viable diagnosis in many of these patients, especially if examined looking for the clinical features of PD.