Parkinson Disease May Be Linked to Increased Drowning Risk

Joaquim J. Ferreira MD, PhD, Faculty of Medicine, University of Lisbon

Joaquim J. Ferreira MD, PhD

New findings suggest that patients with Parkinson disease may have compromised swimming ability, warranting further research into the matter to explore the global frequencies of these difficulties, as well as their identifying factors.¹

The data, from Joaquim J. Ferreira MD, PhD, Faculty of Medicine, University of Lisbon, and colleagues were collected in a small evaluation of 13 patients with Parkinson disease, of which 3 were able to swim, as defined by the study. The results reinforce the attention needed for this issue, and suggest that a formal assessment of swimming performance is required to recommend safety measures and reduce the risk of drowning.

Notably, 11 of the study’s patients—85%—performed hydrotherapy on a regular basis.

“Our results support Parkinson patients’ complaints about swimming difficulties, especially when a second task is added. The difficulties moving the lower limbs, coordination, and maintaining the horizontal position seem to be major problems,” they wrote.

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In total, 12 of the patients could participate in the breaststroke test. Only 46% (n = 6) of patients were able to maintain coordination for their lower limbs, while all patients maintained upper limb coordination. Moments of hesitation or blockage in the upper or lower limbs were present in 33% (n = 4). The capacity to stay afloat and maintain a horizontal position was only achieved by 25% (n = 3).

In the presence of obstacles, 11 patients completed the test. Of those 91% (n = 10) maintained coordination of the upper limbs and 55% (n = 6) of the lower. Moments of hesitation or blockage were present in 64% (n = 7). Only 18% (n = 2) managed to stay afloat and maintain a horizontal position.

The patients' baseline Unified Parkinson’s Disease Rating Scale (UPDRS) total score was 53.5 ± 14.9, with a part III score of 28.0 ± 2.8 and a mean velocity in the 10 m Walk Test of 0.93 ± 2.2 m/s. No dyskinesia was observed during baseline assessments, nor throughout the assessment.

Notably, case findings from earlier in the year by Waldvogel et al. suggest that one of the potential risk factors to consider is treatment with deep brain stimulation (DBS). They reported 9 cases of patients with Parkinson disease who received subthalamic nucleus DBS and subsequently lost the ability to swim post-procedure.²

Waldvogel et al. shared details from 3 cases: A 69-year-olf man, a 59-year-old woman, and a 61-year-old woman who all lost the ability to swim despite improved motor function and symptom control. “[These] 3 patients (cases 3—5) tried switching off DBS for swimming. All found their ability to swim came back immediately, with improved coordination of the limbs. However, Parkinson motor symptoms deteriorated rapidly; therefore, all decided to switch stimulation on again as soon as possible,” they wrote.

“We do not advocate that Parkinson patients stop swimming or engaging in water activities, which have positive effects,” Ferreira et al. wrote. “However, we believe it to be crucial to establish a formal objective assessment of patients’ swimming ability to identify and provide the necessary security measures to alert for higher risk.”

REFERENCES

1. Neves MA, Bouça‐Machado R, Guerreiro D, et al. Swimming Is Compromised in Parkinson's Disease Patients. Movement Disorders. Published December 4, 2019. doi: 10.1002/mds.27918.

2. Waldvogel D, Baumann-Vogel H, Stieglitz L, et al. Beware of deep water after subthalamic deep brain stimulation. Neurology. Published November 27, 2019, doi: 10.1212/WNL.0000000000008664.