title: Cognitive impairment decreases postural control during dual tasks in geriatric patients with a history of severe falls.
abstract: OBJECTIVE
  To investigate the influence of dual tasks, cognitive strategies, and fear of falling on postural control in geriatric patients with or without cognitive impairment and with a history of falls resulting in injury.
  
  
  METHODS
  Experimental three-group design.
  
  
  METHODS
  Geriatric hospital.
  
  
  METHODS
  Twenty young healthy adults (mean age+/-standard deviation=25.4+/-4.4), 20 geriatric patients with a history of severe falls without cognitive impairment (mean age=82.6+/-5.5, mean Mini-Mental State Examination (MMSE) score=27.8+/-2.0) and 20 geriatric patients with a history of severe falls and cognitive impairment (mean age=83.2+/-5.5, mean MMSE=19.2+/-3.3).
  
  
  METHODS
  Motor performance: sway area and lateral and anterior-posterior sway angles. Cognition: semiautomated calculation steps (serial 2 forward) and nonautomated calculation derived from MMSE (serial 7 retro). Motor and cognitive performances were examined as single and dual tasks. Strategy decision, fear of falling, and subjective perception of motor and cognitive performance were assessed as covariates for dual-task performances.
  
  
  RESULTS
  Motor performance decreased significantly during all dual tasks in geriatric patients with cognitive impairment and a history of falls resulting in injury. Cognitive performance was different depending on the task and group. Choice of cognitive strategies or fear of falling did not influence the dual-task performances.
  
  
  CONCLUSIONS
  Even simple additional tasks substantially decrease postural stability due to attention-related cognitive deficits in cognitively impaired geriatric patients with a history of severe falls. The findings may help to explain the increased incidence and severity of falls in geriatric patients with cognitive impairment and a history of falls resulting in injury.
authors.affiliation: Bethanien-Krankenhaus/Geriatrisches Zentrum am Klinikum der Universität Heidelberg, Heidelberg, Germany. klhauer@web.de
authors.forename: Klaus
authors.initials: K
authors.lastname: Hauer
authors.forename: Mathias
authors.initials: M
authors.lastname: Pfisterer
authors.forename: Christine
authors.initials: C
authors.lastname: Weber
authors.forename: Nikolai
authors.initials: N
authors.lastname: Wezler
authors.forename: Mattias
authors.initials: M
authors.lastname: Kliegel
authors.forename: Peter
authors.initials: P
authors.lastname: Oster
mesh_terms: D000058:Accidental Falls; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003072:Cognition Disorders / Q000503:physiopathology*; D003196:Computer Graphics; D005260:Female; D006801:Humans; D008297:Male; D009434:Neural Pathways / Q000502:physiology; D009483:Neuropsychological Tests; D011187:Posture / Q000502:physiology*