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J Am Med Dir Assoc. 2017 Apr 1;18(4):335-340. doi: 10.1016/j.jamda.2016.10.008. Epub 2016 Nov 30.

Falls, Cognitive Impairment, and Gait Performance: Results From the GOOD Initiative.

Author information

1
Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York; Department of Neurology, Geneva University Hospital and University of Geneva, Geneva, Switzerland. Electronic address: gilles.allali@hcuge.ch.
2
Department of Neuroscience, Division of Geriatric Medicine, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France.
3
Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York; Department of Medicine, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY.
4
Menzies Institute of Medical Research, University of Tasmania, Tasmania, Australia; Department of Medicine, Peninsula Health, Melbourne, Victoria, Australia.
5
Department of Geriatric Medicine, General Hospital ST Maarten, Mechelen, Belgium; Department of Geriatrics, University of Antwerp, Antwerp, Belgium; Department of Primary an Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium.
6
University Center for Medicine of Aging, Felix Platter Hospital and University of Basel, Basel, Switzerland.
7
Menzies Institute of Medical Research, University of Tasmania, Tasmania, Australia; Department of Medicine, Peninsula Health, Melbourne, Victoria, Australia; Central Clinical School, Medicine, Monash University, Victoria, Australia; Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.
8
Centre for Memory and Mobility, Luxembourg city, Luxembourg.
9
Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada; Biomathics, Paris, France.

Abstract

OBJECTIVES:

Falls are highly prevalent in individuals with cognitive decline. The complex relationship between falls and cognitive decline (including both subtype and severity of dementia) and the influence of gait disorders have not been studied. This study aimed to examine the association between the subtype (Alzheimer disease [AD] versus non-AD) and the severity (from preclinical to moderate dementia) of cognitive impairment and falls, and to establish an association between falls and gait parameters during the course of dementia.

DESIGN:

Multicenter cross-sectional study.

SETTING:

"Gait, cOgnitiOn & Decline" (GOOD) initiative.

PARTICIPANTS:

A total of 2496 older adults (76.6 ± 7.6 years; 55.0% women) were included in this study (1161 cognitively healthy individuals [CHI], 529 patients with mild cognitive impairment [MCI], 456 patients with mild dementia, and 350 with moderate dementia) from 7 countries.

MEASUREMENTS:

Falls history was collected retrospectively at baseline in each study. Gait speed and stride time variability were recorded at usual walking pace with the GAITRite system.

RESULTS:

The prevalence of individuals who fall was 50% in AD and 64% in non-AD; whereas it was 25% in CHIs. Only mild and moderate non-AD dementia were associated with an increased risk for falls in comparison with CHI. Higher stride time variability was associated with falls in older adults without dementia (CHI and each MCI subgroup) and mild non-AD dementia, whereas lower gait speed was associated with falls in all participant groups, except in mild AD dementia. When gait speed was adjusted for, higher stride time variability was associated with falls only in CHIs (odds ratio 1.14; P = .012), but not in MCI or in patients with dementia.

CONCLUSIONS:

These findings suggest that non-AD, but not AD dementia, is associated with increased falls in comparison with CHIs. The association between gait parameters and falls also differs across cognitive status, suggesting different mechanisms leading to falls in older individuals with dementia in comparison with CHIs who fall.

KEYWORDS:

Falls; dementia; gait disorders; mild cognitive impairment

PMID:
27914848
PMCID:
PMC5366266
DOI:
10.1016/j.jamda.2016.10.008
[Indexed for MEDLINE]
Free PMC Article

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