Examining Balance and the Likelihood of Falls in Huntington's Disease.

Background: Balance impairment may begin prior to motor diagnosis in Huntington's disease (HD) and is associated with an increased risk of falls-an important predictor of nursing home placement. Objective: To evaluate the ability of three balance measures to discriminate between Fallers and Non-Fallers and to estimate the likelihood of falling in HD patients. Methods: 125 gene-positive individuals were stratified into Fallers (n = 30) and Non-Fallers (n = 95) based on fall history. Participants completed a Total Body Sway (TBS) assessment using the BTrackS™ Balance Plate, Timed Up-and-Go (TUG), and Chair Sit-to-Stand Test (CST). Group differences were analyzed with Mann-Whitney U test. ROC curve analysis was used to calculate likelihood ratios (LRs) for each assessment's ability to distinguish Fallers from Non-Fallers. Results: Fallers demonstrated significantly higher TBS scores compared to Non-Fallers (p < 0.001), while differences on TUG (p = 0.098) and CST (p = 1.00) were not significant. TBS yielded the highest area under the curve (AUC = 0.89, p < 0.001), followed by TUG (AUC = 0.66, p = 0.008), while CST did not discriminate between groups (AUC = 0.47, p = 0.617). TBS also demonstrated superior diagnostic utility (LR+ = 5.06; LR- = 0.24) compared to TUG (LR+ = 3.41; LR- = 0.62) and CST (LR+ = 1.59; LR- = 0.90). Conclusion: TBS and, to a lesser extent, TUG are valid tools for identifying individuals at risk of falling in HD. In contrast, the CST may not be an effective clinical measure in this regard.