{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:20:11Z","timestamp":1787026811001,"version":"build-2736575974"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Falls are frequent and debilitating complications in Parkinson\u2019s disease (PD), with a substantial risk present even in early stages. Predicting the first fall is critical for preventive interventions, yet existing models are often unsuitable for fall-naive, early PD patients due to their reliance on fall history.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to develop and externally validate a clinical prediction model for first falls in a population of fall-naive, early PD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This prognostic model study used data from two cohorts: the Parkinson\u2019s Progression Markers Initiative (PPMI) for model development (\n                      <jats:italic>n<\/jats:italic>\n                      = 283) and internal validation (\n                      <jats:italic>n<\/jats:italic>\n                      = 120), and an independent Chinese cohort for external validation (\n                      <jats:italic>n<\/jats:italic>\n                      = 150). Participants were fall-naive with early PD (Hoehn and Yahr stage 1\u20132) and were followed for 36 months. The primary outcome was time to the first fall. A Cox proportional hazards model was developed using readily accessible clinical variables. Model performance was assessed using discrimination (C-index, AUC), calibration, and decision curve analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During follow-up, 16.9% of PPMI participants and 20.7% of the Chinese cohort experienced a first fall. The final model incorporated five independent predictors: lower body mass index, asymptomatic orthostatic hypotension, lower Montreal Cognitive Assessment score, a Geriatric Depression Scale-15 score &amp;gt; 5, and a higher postural instability and gait disorder score. The model demonstrated good discrimination with an optimism-corrected C-index of 0.844 in the training set and maintained its performance in both internal (C-index: 0.768) and external validation (C-index: 0.825). Decision curve analysis indicated that the model demonstrated superior clinical net benefit for predicting falls over 36 months compared to 18 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A history of falls is not necessary to predict the first fall in early PD. Our externally validated model, based on five easily ascertainable clinical factors, provides a practical tool for early risk stratification and can help guide individualized preventive strategies to delay or prevent initial falls in this vulnerable population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnagi.2026.1735524","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T06:34:13Z","timestamp":1771310053000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Development and validation of a clinical prediction model for first fall in early Parkinson\u2019s disease: a study of two fall-naive cohorts"],"prefix":"10.3389","volume":"18","author":[{"given":"Yu","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianing","family":"Mei","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunzhe","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongping","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zijun","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingliang","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueyi","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiyuan","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunyun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.parkreldis.2008.03.010","article-title":"Impaired attention predicts falling in Parkinson\u2019s disease.","volume":"15","author":"Allcock","year":"2009","journal-title":"Parkinsonism Relat. 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