title: Increased risk for falling associated with subtle cognitive impairment: secondary analysis of a randomized clinical trial.
abstract: OBJECTIVE
  Having dementia increases patients' risk for accidental falls. However, it is unknown if having mild cognitive deficits also elevates a person's risk for falls. This study sought to clarify the relationship between subtle cognitive impairment, measured with a widely-used, clinic-based assessment, the Mini Mental State Exam (MMSE), and risk for falls.
  
  
  METHODS
  In a secondary analysis of the Kenosha County Falls Prevention Study, a randomized controlled trial targeting older adults at risk for falls, we examined the association between baseline MMSE and prospective rate of falls over 12 months in 172 subjects randomized to control group.
  
  
  RESULTS
  Using univariate analysis, the rate of falls increased with each unit decrease in MMSE score down to at least 22 (rate ratio 1.25, 95% confidence interval (CI) 1.09-1.45, p = 0.0026). Using stepwise multivariate regression, controlling for ability to perform activities of daily living, use of assistive device, current exercise, and arthritis, the association between MMSE score and falls rate persisted (rate ratio 1.20, 95% CI 1.03-1.40, p = 0.021).
  
  
  CONCLUSIONS
  Minimal decrements on the MMSE were associated with elevations in rate of falls, suggesting that subtle cognitive deficits reflected in MMSE scores above a cut-off consistent with a diagnosis of dementia, can influence risk for falls.
authors: Section of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin, Madison, Wisconsin 53705, USA. ceg@medicine.wisc.edu
authors: Carey E
authors: CE
authors: Gleason
authors: Ronald E
authors: RE
authors: Gangnon
authors: Barbara L
authors: BL
authors: Fischer
authors: Jane E
authors: JE
authors: Mahoney
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications* / Q000523:psychology*; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires