Exploring Contributors to Fear-Based Activity Avoidance in Parkinson Disease: A Cross-Sectional Analysis of Depression, Balance, and Disease Severity

Background and Purpose: Fear of falling (FoF) avoidance behavior (FFAB) is common in Parkinson disease (PD) and contributes to reduced activity, deconditioning, and functional decline. Although depression, anxiety, fatigue, cognition, balance, and motor severity have been examined in relation to FoF, few studies have evaluated them simultaneously. The purpose of this exploratory study was to identify the relative contributions of affective, cognitive, fatigue-related, balance, and motor factors associated with FFAB in individuals with early-stage PD and to generate hypotheses for future investigation. Methods: A cross-sectional secondary analysis was conducted in mild to moderate PD (Hoehn and Yahr stages 1-3, n = 35). Participants completed measures of FFAB (modified FFAB Questionnaire), fatigue (Movement Disorder Society Unified Parkinson Disease Rating Scale [MDS-UPDRS] Part I, item 13), mood (Parkinson Anxiety Scale and Geriatric Depression Scale), cognition (Mini-Mental State Exam, Trail Making Test Parts A and B, and Symbol Digit Modalities Test), balance (MiniBESTest [MBT]), and motor severity (MDS-UPDRS Part III). Bivariate correlations were computed between FFAB and candidate predictors, followed by Elastic Net regression. Results: Modified FFAB Questionnaire scores were strongly correlated with depressive symptoms and balance. Elastic Net regression retained 11 variables, including Geriatric Depression Scale ( β = 616), MBT ( β = −0.469), MDS-UPDRS Part III ( β = 0.156), sex ( β = 0.183), Trail Making Test Part A ( β = 0.115), and fatigue ( β = 0.050). Bootstrap confidence intervals indicated that MBT demonstrated the most stable association with FFAB (95% confidence interval: −0.703, −0.169). Discussion and Conclusions: FFAB in early-stage PD appears strongly associated with depressive symptoms and balance impairment, with modest contributions from motor severity. These exploratory findings identify affective and physical factors as promising targets for research aimed at understanding FFAB.