For people with Parkinson's disease, there are fall risk factors specific to PD. These include changes in posture, postural instability, freezing of gait, dyskinesias, gait changes, medication side effects, and decreased ability to react automatically to a loss of balance. Health and cognitive factors such as cognitive decline and depression can also greatly increase the risk of falling. Contreras and Grandas (2012) conducted a study in Spain that included 160 people with Parkinson's disease who were being seen at a movement disorders clinic in Madrid. It was found that that fallers were older and had longer disease duration (Contreras & Grandas, 2012). Subjects also had increased disease severity according to the UPDRS (part III) and the Hoehn and Yahr scale, and lower scores on the Schwab and England ADL test (Contreras & Grandas, 2012). In addition, fallers scored worse in the Mini-Mental State Examination and experienced a higher frequency of motor fluctuations, dyskinesia, and freezing of gait (Contreras & Grandas, 2012).