title: Neuropsychological, physical, and functional mobility measures associated with falls in cognitively impaired older adults.
abstract: BACKGROUND
  Older people with cognitive impairment have an elevated fall risk, with 60% falling annually. There is a lack of evidence for fall prevention in this population, in part due to limited understanding of risk factors. This study examined fall risk in older people with cognitive impairment with an emphasis on identifying explanatory and modifiable risk factors.
  
  
  METHODS
  One hundred and seventy-seven community-dwelling older people with mild-moderate cognitive impairment (Mini-Mental State Examination 11-23/Addenbrooke's Cognitive Examination-Revised <83) underwent neuropsychological, physical, and functional assessments. Falls were recorded prospectively for 12 months with the assistance of carers.
  
  
  RESULTS
  Of the 174 participants available to follow-up, 111 (64%) fell at least once and 71 (41%) at least twice. Higher fall rates were associated with slower reaction time, impaired balance (sway on floor and foam, semitandem, near-tandem, tandem stance), and reduced functional mobility (co-ordinated stability, timed up-and-go, steps needed to turn 180°, sit-to-stand, gait velocity). Higher fall rates were also associated with increased medication use (central nervous system, total number) and poorer performances in cognitive (Addenbrooke's Cognitive Examination-Revised: visuospatial domain, cube drawing; Trail-Making Test) and psychological (Geriatric Depression Scale, Goldberg Anxiety Scale, Falls Efficacy Scale-International) tests. Multivariate analysis identified increased sway on foam, co-ordinated stability score, and depressive symptoms to be significantly and independently associated with falls while controlling for age, years of education, and Addenbrooke's Cognitive Examination-Revised score.
  
  
  CONCLUSIONS
  This study identified several risk factors of falls in older people with cognitive impairment, a number of which are potentially modifiable. Future research involving targeted interventions addressing medication use, balance, mood, and functional performance may prove useful for fall prevention in this population.
authors.affiliation: Falls and Balance Research Group, Neuroscience Research Australia, Prince of Wales Clinical School, Medicine.
authors.forename: Morag E
authors.initials: ME
authors.lastname: Taylor
authors.affiliation: Falls and Balance Research Group, Neuroscience Research Australia, School of Public Health and Community Medicine, Medicine, and.
authors.forename: Kim
authors.initials: K
authors.lastname: Delbaere
authors.affiliation: Falls and Balance Research Group, Neuroscience Research Australia, School of Public Health and Community Medicine, Medicine, and.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Lord
authors.affiliation: Falls and Balance Research Group, Neuroscience Research Australia, School of Public Health and Community Medicine, Medicine, and.
authors.forename: A Stefanie
authors.initials: AS
authors.lastname: Mikolaizak
authors.forename: Henry
authors.initials: H
authors.lastname: Brodaty
authors.affiliation: Prince of Wales Clinical School, Medicine, Falls and Injury Prevention Group, Neuroscience Research Australia, UNSW, Sydney, Australia. j.close@neura.edu.au.
authors.forename: Jacqueline C T
authors.initials: JC
authors.lastname: Close
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000339:Affect / Q000502:physiology; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000503:physiopathology / Q000523:psychology; D060825:Cognitive Dysfunction / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D004856:Postural Balance; D011446:Prospective Studies; D012307:Risk Factors
keywords: Accidental falls; Aged; Balance; Dementia; Depression.