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Author Notes:

J. Lucas McKay, PhD MSCR, Room W-202, Health Sciences Research Building, 1760 Haygood Dr NE, Atlanta, GA 30322, j.lucas.mckay@emory.edu, (404) 550-5157 (voice), (404) 727-9873 (fax)

Research project: Conception, JLM, LHT, MEH; Organization, JLM, KCL, LHT, MEH; Execution, JLM, KCL, LHT, MEH. Statistical Analysis: Design and Execution: JLM; Review and Critique: LHT, MEH. Manuscript Preparation: Writing of the first draft: JLM; Review and Critique, KCL, LHT, MEH.

Authors declared no conflicts of interest.


Research Funding:

This work was supported by the National Institutes of Health (NIH) UL1 TR000454, KL2 TR000455, TL1 TR000456, R21 HD075612, K25 HD086276; and the Department of Veterans Affairs R&D Service N0870W; the Dan and Merrie Boone Foundation; and the Emory Center for Injury Control.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Neurosciences
  • Orthopedics
  • Sport Sciences
  • Neurosciences & Neurology
  • Balance
  • Freezing of gait
  • FOG
  • Executive function
  • Frontostriatal
  • GAIT

Impaired set shifting is associated with previous falls in individuals with and without Parkinson's disease


Journal Title:

Gait and Posture


Volume 62


, Pages 220-226

Type of Work:

Article | Post-print: After Peer Review


Background: Individuals with Parkinson's disease (PD) are at increased risk for falls, which lead to substantial morbidity and mortality. Understanding the motor and non-motor impairments associated with falls in PD is critical to informing prevention strategies. In addition to motor symptoms, individuals with PD exhibit non-motor deficits, including impaired set shifting, an aspect of executive function related to cognitive flexibility that can be measured quickly with the Trailmaking Test. Research question: To determine whether impaired set shifting is associated with fall history in people with and without PD. Methods: We examined associations between set shifting, PD status, and fall history (≥1 falls in the previous 6 months) in data from PD patients (n = 65) with and without freezing of gait (FOG) and community-dwelling neurologically-normal older adults (NON-PD) (n = 73) who had participated in our rehabilitation studies. Results: Impaired set shifting was associated with previous falls after controlling for age, sex, overall cognitive function, PD status, FOG, and PD disease duration (OR = 1.29 [1.03–1.60]; P = 0.02). Consistent with literature, PD and FOG were also independently associated with increased fall prevalence (PD OR = 4.15 [95% CI 1.65–10.44], P < 0.01; FOG OR = 3.63 [1.22–10.80], P = 0.02). Although the strongest associations between set shifting and falling were observed among PD without FOG (OR = 2.11) compared to HOA (OR = 1.14) and PD with FOG (OR = 1.46), no statistically-significant differences were observed across groups. SIGNIFICANCE. Impaired set shifting is associated with previous falls in older adults with and without PD. Set shifting may be useful to include in fall risk assessments, particularly when global cognitive measures are within reference limits.

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© 2018 Elsevier B.V.All rights reserved.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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