The role of cognitive impairment in fall risk among older adults: A systematic review and meta-analysis

Division of Geriatric Medicine, The University of Western Ontario, 801 Commissioners Road East, London, Ontario, Canada.
Age and Ageing (Impact Factor: 3.64). 02/2012; 41(3):299-308. DOI: 10.1093/ageing/afs012
Source: PubMed


cognitive impairment is an established fall risk factor; however, it is unclear whether a disease-specific diagnosis (i.e. dementia), measures of global cognition or impairments in specific cognitive domains (i.e. executive function) have the greatest association with fall risk. Our objective was to evaluate the epidemiological evidence linking cognitive impairment and fall risk.
studies were identified through systematic searches of the electronic databases of MEDLINE, EMBASE, PyschINFO (1988-2009). Bibliographies of retrieved articles were also searched. A fixed-effects meta-analysis was performed using an inverse-variance method.
twenty-seven studies met the inclusion criteria. Impairment on global measures of cognition was associated with any fall, serious injuries (summary estimate of OR = 2.13 (1.56, 2.90)) and distal radius fractures in community-dwelling older adults. Executive function impairment, even subtle deficits in healthy community-dwelling older adults, was associated with an increased risk for any fall (summary estimate of OR = 1.44 (1.20, 1.73)) and falls with serious injury. A diagnosis of dementia, without specification of dementia subtype or disease severity, was associated with risk for any fall but not serious fall injury in institution-dwelling older adults.
the method used to define cognitive impairment and the type of fall outcome are both important when quantifying risk. There is strong evidence global measures of cognition are associated with serious fall-related injury, though there is no consensus on threshold values. Executive function was also associated with increased risk, which supports its inclusion in fall risk assessment especially when global measures are within normal limits.

    • "All variables were included in the models as categorical variables with the exception of grip strength and gait speed (continous variables). The selection of the covariates was based on past literature (Muir et al., 2012; Tinetti et al., 1995; Tinetti et al., 1986; Robbins et al., 1989). In order to assess the influence of multicolinearity, we calculated the variance inflation factor (VIF) value for each independent variable. "
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    ABSTRACT: Introduction: The role of mild cognitive impairment (MCI) on falls among older adults remains under-investigated. The aim of this study was to evaluate the association between MCI and number of falls or occurrence of non-accidental falls among older adults. Methods: Data from the first wave of the Irish longitudinal Study on Ageing (TILDA) was analysed. The analytical sample consisted of 5364 individuals aged ≥50 years. MCI was defined as: Montreal Cognitive Assessment (MoCA) score<26; presence of subjective cognitive complaints; Mini-Mental State Examination (MMSE) score≥14; and no limitations in activities of daily living (ADL). Multivariable poisson and logistic regression analyses were conducted to assess the association between MCI and number of falls or presence of non-accidental falls in the past 12 months. Results: The prevalence of MCI was 10.1%. In the fully-adjusted model, MCI was associated with a higher rate of falls (PR=1.41 95%CI=1.05-1.89) and odds for non-accidental falls in the past 12 months (OR=1.67 95%CI=1.07-2.61). Muscle strength and performance indicators, and medical health conditions were influential factors in the association between MCI and falls but did not fully explain the association. Conclusion: MCI is related with higher rates of falls and the occurrence of non-accidental falls among older adults. Future studies are warranted to clarify the underlying mechanism linking MCI and falls, and to establish interventions targeting MCI to reduce the risk of falls.
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    • "In particular, Nagamatsu et al. (2011) revealed that baseline activation of left orbital frontocortex and anterior cingulate gyrus were both associated with falls risk in community-dwelling seniors. Since the earlier reports on the connection between cognitive performance and balance there now exists a vast collection of reports that clearly expose the link between reduced cognitive capacity and heightened falls risk (Ambrose et al., 2013; Chen et al., 2012; Herman et al., 2010; Holtzer et al., 2007; Liu-Ambrose et al., 2008; Mirelman et al., 2012; Morris et al., 1987; Muir et al., 2012) even when the cognitive decline is slight (Gleason et al., 2009). "
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    ABSTRACT: The ease with which we avoid falling down belies a highly sophisticated and distributed neural network for controlling reactions to maintain upright balance. Although historically these reactions were considered within the sub cortical domain, mounting evidence reveals a distributed network for postural control including a potentially important role for the cerebral cortex. Support for this cortical role comes from direct measurement associated with moments of induced instability as well as indirect links between cognitive task performance and balance recovery. The cerebral cortex appears to be directly involved in the control of rapid balance reactions but also setting the central nervous system in advance to optimize balance recovery reactions even when a future threat to stability is unexpected. In this review the growing body of evidence that now firmly supports a cortical role in the postural responses to externally induced perturbations is presented. Moreover, an updated framework is advanced to help understand how cortical contributions may influence our resistance to falls and on what timescale. The implications for future studies into the neural control of balance are discussed. Copyright © 2015. Published by Elsevier Ltd.
    Full-text · Article · Aug 2015 · Neuroscience & Biobehavioral Reviews
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    • "With aging, individuals are more likely to present muscle weakness (Leveille et al., 2009), change in postural control (Sorond et al., 2010), chronic pain (Stubbs et al., 2014), peripheral neuropathy and proprioceptive sensory loss (Richardson and Hurvitz, 1995), vision impairment (Yip et al., 2014), vestibular dysfunctions, hypoacusia (Viljanen et al., 2009), cognitive decline (Muir et al., 2012), and orthostatic hypotension. All these aspects have been related to an increased tendency to fall in the elderly; moreover, multiple medical illness, drugs, and polypharmacy (Berry et al., 2010), which are very common among the elderly, have been related to an increased risk of falling. "
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    ABSTRACT: We investigated the effectiveness of three different rehabilitative programs: group exercise, individual core stability or balance training intervention with a stabilometric platform to improve balance ability in elderly hospitalized patients. We used a prospective quasi-experimental study design. Twenty-eight patients, 39.3% women [age (mean±SD) 72.4±6.5 years], known to have had at least a fall in the last 12 months, were consecutively assigned to one of the following three groups: group exercise intervention, individual core stability or balance training with a stabilometric platform (five sessions a week for 3 weeks in each group). Outcomes were collected at baseline and immediately following the intervention period. In each intervention group, patients showed improvement in balance and mobility, shown as an improvement in the three functional tests score (the Tinetti scale, the Berg Balance Scale, and the Time Up and Go test) (all, P<0.05), whereas, generally, the changes in the score of the test of the stabilometric platform (Postural Stability Test and Fall Risk Test) were not significant for all the interventions. No significant group-by-time interaction was detected for any of the intervention groups, which suggests that the groups improved in the same way. These findings indicate that participation in an exercise program can improve balance and functional mobility, which might contribute toward the reductions of the falls of elderly hospitalized patients and the subsequent fall-related costs. Functional scales might be more appropriate than an instrumental test (Postural Stability Test and Fall Risk Test of the Biodex Balance System) in detecting the functional improvement because of a rehabilitative intervention.
    Full-text · Article · Jul 2015 · International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation
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