title: Cognitive dysfunction associated with falls in progressive supranuclear palsy.
abstract: BACKGROUND
  Attentional and executive dysfunctions are associated with falls in community-dwelling elderly individuals and patients with PD. Frontal cognitive dysfunction and falls are frequent symptoms of PSP. We studied to identify the cognitive domains associated with recurrent falls in patients with PSP.
  
  
  METHODS
  We performed a battery of neuropsychological tests in 59 individuals with probable PSP. We categorized patients into infrequent fall (≤one fall during the last 12 months, n=29) or recurrent fall (≥two falls during the last 12 months, n=30) groups.
  
  
  RESULTS
  UPDRS subscores for axial deficits were significantly higher in the recurrent fall group than the infrequent fall group, but there were no significant differences in UPDRS total motor scores or subscores for bradykinesia, rigidity, and tremor. There was no difference between groups in MMSE scores. ANCOVA with adjustment for confounding factors showed that, recurrent falls were associated with abnormalities in alternating hand movement, alternating square and triangle, RCFT copying task, and ideomotor apraxia. Group difference of abnormalities in Stroop test was marginal (p=0.054). However, there were no group differences in the frequency of abnormalities in forward or backward digit span, motor impersistence, fist-edge-palm, contrast programming, go-no-go, Luria loop drawing, or Controlled Oral Word Association Tests. Recurrent falls were not associated with memory or language dysfunction.
  
  
  CONCLUSIONS
  Recurrent falls in patients with PSP were associated mainly with executive and visuospatial dysfunctions, including (1) impaired coordinated alternating uni- and bimanual motor programming and execution, (2) deficit of attention and decision making in the presence of interference, (3) visuospatial misperception and (4) ideomotor apraxia.
authors.affiliation: Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Republic of Korea.
authors.forename: Sha-Lom
authors.initials: SL
authors.lastname: Kim
authors.affiliation: Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Republic of Korea.
authors.forename: Myung-Jun
authors.initials: MJ
authors.lastname: Lee
authors.affiliation: Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Republic of Korea. Electronic address: mslee@yuhs.ac.
authors.forename: Myung-Sik
authors.initials: MS
authors.lastname: Lee
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D001288:Attention / Q000502:physiology; D003072:Cognition Disorders / Q000209:etiology / Q000503:physiopathology*; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012307:Risk Factors; D013494:Supranuclear Palsy, Progressive / Q000150:complications / Q000503:physiopathology*
keywords: Executive dysfunction; Fall; Progressive supranuclear palsy; Visuospatial dysfunction