The Role of Cognitive Factors in Predicting Balance and Fall Risk in a Neuro-Rehabilitation Setting.
There is a consistent body of evidence supporting the role of cognitive functions, particularly executive function, in the elderly and in neurological conditions which become more frequent with ageing. The aim of our study was to assess the role of different domains of cognitive functions to predict balance and fall risk in a sample of adults with various neurological conditions in a rehabilitation setting.



This was a prospective, cohort study conducted in a single centre in the UK. 114 participants consecutively admitted to a Neuro-Rehabilitation Unit were prospectively assessed for fall accidents. Baseline assessment included a measure of balance (Berg Balance Scale) and a battery of standard cognitive tests measuring executive function, speed of information processing, verbal and visual memory, visual perception and intellectual function. The outcomes of interest were the risk of becoming a faller, balance and fall rate.



Two tests of executive function were significantly associated with fall risk, the Stroop Colour Word Test (IRR 1.01, 95% CI 1.00-1.03) and the number of errors on part B of the Trail Making Test (IRR 1.23, 95% CI 1.03-1.49). Composite scores of executive function, speed of information processing and visual memory domains resulted in 2 to 3 times increased likelihood of having better balance (OR 2.74 95% CI 1.08 to 6.94, OR 2.72 95% CI 1.16 to 6.36 and OR 2.44 95% CI 1.11 to 5.35 respectively).



Our results show that specific subcomponents of executive functions are able to predict fall risk, while a more global cognitive dysfunction is associated with poorer balance.
Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom.|Institute of Rehabilitation, Fondazione Salvatore Maugeri, Genova, Italy.|Wolfson Neurorehabilitation Centre, St Georges Hospital, London, United Kingdom.
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Saverino
Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom.
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Waller
Research Support Centre, Joint UCL/UCLH/Royal Free Hospital, London, United Kingdom.|Institute of Neurology, University College London, London, United Kingdom.
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Rantell
Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom.
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Parry
Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom.
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Moriarty
Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom.|Institute of Neurology, University College London, London, United Kingdom.
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Playford
D000058:Accidental Falls / Q000517:prevention & control; D000328:Adult; D000375:Aging / Q000502:physiology / Q000523:psychology; D003071:Cognition / Q000502:physiology*; D015331:Cohort Studies; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000503:physiopathology / Q000523:psychology* / Q000534:rehabilitation*; D000066530:Neurological Rehabilitation; D009483:Neuropsychological Tests; D004856:Postural Balance / Q000502:physiology*; D011446:Prospective Studies; D012307:Risk Factors