Executive function predicts risk of falls in older adults without balance impairment

Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR-131, Portland, OR 97239 USA.
BMC Geriatrics (Impact Factor: 1.68). 11/2011; 11(1):74. DOI: 10.1186/1471-2318-11-74
Source: PubMed


Executive dysfunction has previously been found to be a risk factor for falls. The aim of this study is to investigate the association between executive dysfunction and risk of falling and to determine if this association is independent of balance.
Participants were 188 community-dwelling individuals aged 65 and older. All participants underwent baseline and annual evaluations with review of health history, standardized neurologic examination, neuropsychological testing, and qualitative and quantitative assessment of motor function. Falls were recorded prospectively using weekly online health forms.
During 13 months of follow-up, there were 65 of 188 participants (34.6%) who reported at least one fall. Univariate analysis showed that fallers were more likely to have lower baseline scores in executive function than non-fallers (p = 0.03). Among participants without balance impairment we found that higher executive function z-scores were associated with lower fall counts (p = 0.03) after adjustment for age, sex, health status and prior history of falls using negative binomial regression models. This relationship was not present among participants with poor balance.
Lower scores on executive function tests are a risk factor for falls in participants with minimal balance impairment. However, this effect is attenuated in individuals with poor balance where physical or more direct motor systems factors may play a greater role in fall risk.

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Available from: Hiroko Hayama Dodge, Oct 06, 2015
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    • "the DT , but not single - task performance ( Killane et al . , 2014 ) . Executive function and attention ( but not visual - spatial , memory or global cognition ) have also been shown to correlate with , and prospectively predict falls in undiagnosed older adults ( Mirelman et al . , 2012 ; see also Holtzer et al . , 2005 ; Herman et al . , 2010 ; Buracchio et al . , 2011 ) . The DT review by Al - Yahya et al . ( 2011 ) also highlighted a large problem of methodological variability in the DT literature , which has ramifications for translation to the clinical setting . Previous studies have often employed only one executive function DT , or have failed to include non - executive tasks for relative compar"
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    ABSTRACT: The role of cognition is becoming increasingly central to our understanding of the complexity of walking gait. In particular, higher-level executive functions are suggested to play a key role in gait and fall-risk, but the specific underlying neurocognitive processes remain unclear. Here, we report two experiments which investigated the cognitive and neural processes underlying older adult gait and falls. Experiment 1 employed a dual-task (DT) paradigm in young and older adults, to assess the relative effects of higher-level executive function tasks (n-Back, Serial Subtraction and visuo-spatial Clock task) in comparison to non-executive distracter tasks (motor response task and alphabet recitation) on gait. All DTs elicited changes in gait for both young and older adults, relative to baseline walking. Significantly greater DT costs were observed for the executive tasks in the older adult group. Experiment 2 compared normal walking gait, seated cognitive performances and concurrent event-related brain potentials (ERPs) in healthy young and older adults, to older adult fallers. No significant differences in cognitive performances were found between fallers and non-fallers. However, an initial late-positivity, considered a potential early P3a, was evident on the Stroop task for older non-fallers, which was notably absent in older fallers. We argue that executive control functions play a prominent role in walking and gait, but the use of neurocognitive processes as a predictor of fall-risk needs further investigation. Citation: Walshe EA, Patterson MR, Commins S and Roche RAP (2015) Dual-task and electrophysiological markers of executive cognitive processing in older adult gait and fall-risk. Front. Hum. Neurosci. 9:200.
    Frontiers in Human Neuroscience 05/2015; 9(200). DOI:10.3389/fnhum.2015.00200 · 2.99 Impact Factor
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    • "Executive deficits can be associated with falls of any kind (Muir et al., 2012). In prospective studies, fallers are more likely to have poorer baseline executive functions than non-fallers at the follow-up, which is held 13 months after cognitive assessment (Buracchio et al., 2011). It is also evident that, in healthy older adults, those with executive functions in the lowest quartile are three times as likely to fall, at a 2 year follow-up (Herman et al., 2010). "
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    ABSTRACT: Falls, a common cause of injury among older adults, have become increasingly prevalent. As the world's population ages, the increase in-and the prevalence of-falls among older people makes this a serious and compelling societal and healthcare issue. Physical weakness is a critical predictor in falling. While considerable research has examined this relationship, comprehensive reviews of neuropsychological predictors of falls have been lacking. In this paper, we examine and discuss current studies of the neuropsychological predictors of falls in older adults, as related to sporting and non-sporting contexts. By integrating the existing evidence, we propose that brain aging is an important precursor of the increased risk of falls in older adults. Brain aging disrupts the neural integrity of motor outputs and reduces neuropsychological abilities. Older adults may shift from unconscious movement control to more conscious or attentive motor control. Increased understanding of the causes of falls will afford opportunities to reduce their incidence, reduce consequent injuries, improve overall well-being and quality of life, and possibly to prolong life.
    Frontiers in Aging Neuroscience 04/2014; 6:64. DOI:10.3389/fnagi.2014.00064 · 4.00 Impact Factor
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    • "Further, neuropsychological measures of memory have been found to be the best predictors of basic activities of daily living, and executive function measures are the best predictors of higher-level activities, such as taking care of finances (Farias, Harrell, Neuman, & Houtz, 2003). Better executive functioning has also been associated with fewer falls (Buracchio et al., 2011). Thus, improvements in these domains may improve self-sufficiency and, therefore, quality of life. "
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    ABSTRACT: In a pilot investigation we evaluated the impact of a structured early memory loss (EML) program intervention in a longitudinal (repeated measures) study of 55 persons with mild cognitive impairment or mild dementia. At four test sites we examined whether participation in the club—which sought to stimulate mental activity and social interaction, provide opportunities for light exercise, and teach memory strategies—would be associated with changes in cognitive function during 1 year. Controlling for relevant covariates, we found that club participation was associated with improvements in two of three executive function measures and maintenance of function in two of three memory measures. We observed decline, over time, on a measure of delayed recall. There were interactions between change and test site, indicating that some effects were related to where clubs were located. This pilot study suggests that EML clubs may be an efficacious, nonpharmacologic intervention for people with early memory loss. However, further research (especially randomized control trials) is needed before recommending widespread implementation of this program.
    Activities Adaptation & Aging 03/2014; 38(1):29-52. DOI:10.1080/01924788.2014.878873
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