OBJECTIVES: To test the hypothesis that methylphenidate modifies markers of fall risk in older adults. DESIGN: Randomized, double-blind, placebo-controlled, single-dose cross-over study. SETTING: Outpatient movement disorders clinic. PARTICIPANTS: Twenty-six community-living older adults without dementia (mean age 73.8) with subjective complaints of "memory problems." INTERVENTIONS: The study examined the effects of a single dose of 20 mg of methylphenidate (MPH) on cognitive function and gait. Participants were evaluated before and 2 hours after taking MPH or a placebo in sessions 1 to 2 weeks apart. MEASUREMENTS: The Timed Up and Go and gait variability quantified mobility and fall risk. A computerized neuropsychology battery quantified memory and executive function (EF). RESULTS: Timed Up and Go times, stride time variability, and measures of EF significantly improved in response to MPH but not in response to the placebo. In contrast, MPH did not significantly affect memory or finger tapping abilities. CONCLUSION: In older adults, MPH appears to improve certain aspects of EF, mobility, and gait stability. Although additional studies are required to assess clinical utility and efficacy, the present findings suggest that methylphenidate and other drugs that are designed to enhance attention may have a role as a therapeutic option for reducing fall risk in older adults.