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Vol. 27, No. 6, 2009
Issue release date: July 2009
Section title: Original Research Article
Free Access
Dement Geriatr Cogn Disord 2009;27:557–563
(DOI:10.1159/000228257)

Increased Risk for Falling Associated with Subtle Cognitive Impairment: Secondary Analysis of a Randomized Clinical Trial

Gleason C.E.a, c · Gangnon R.E.b · Fischer B.L.d · Mahoney J.E.a
aSection of Geriatrics and Gerontology, Department of Medicine, and bDepartments of Biostatistics and Medical Informatics and Population Health Sciences, University of Wisconsin, cGeriatric Research, Education and Clinical Center (GRECC), and dMental Health Service, William S. Middleton Memorial Veterans Hospital, Madison, Wisc., USA
email Corresponding Author

Abstract

Background/Aims: Having dementia increases patients’ risk for accidental falls. However, it is unknown if having mild cognitive deficits also elevates a person’s risk for falls. This study sought to clarify the relationship between subtle cognitive impairment, measured with a widely-used, clinic-based assessment, the Mini Mental State Exam (MMSE), and risk for falls. Methods: In a secondary analysis of the Kenosha County Falls Prevention Study, a randomized controlled trial targeting older adults at risk for falls, we examined the association between baseline MMSE and prospective rate of falls over 12 months in 172 subjects randomized to control group. Results: Using univariate analysis, the rate of falls increased with each unit decrease in MMSE score down to at least 22 (rate ratio 1.25, 95% confidence interval (CI) 1.09–1.45, p = 0.0026). Using stepwise multivariate regression, controlling for ability to perform activities of daily living, use of assistive device, current exercise, and arthritis, the association between MMSE score and falls rate persisted (rate ratio 1.20, 95% CI 1.03–1.40, p = 0.021). Conclusion: Minimal decrements on the MMSE were associated with elevations in rate of falls, suggesting that subtle cognitive deficits reflected in MMSE scores above a cut-off consistent with a diagnosis of dementia, can influence risk for falls.

© 2009 S. Karger AG, Basel


  

Key Words

  • Accidental falls
  • Falls
  • Mini Mental State Exam
  • Cognition
  • Geriatrics
  • Older adults
  • Risk factors

References

  1. Horikawa E, Matsui T, Arai H, Seki T, Iwasaki K, Sasaki H: Risk of falls in Alzheimer’s disease: a prospective study. Intern Med 2005;44:717–721.
  2. Folstein MF, Folstein SE, McHugh PR: ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  3. Anstey KJ, von Sanden C, Luszcz MA: An 8-year prospective study of the relationship between cognitive performance and falling in very old adults. J Am Geriatr Soc 2006;54:1169–1176.
  4. Tinetti ME, Speechley M, Ginter SF: Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319:1701–1707.
  5. Graafmans WC, Ooms ME, Hofstee HM, Bezemer PD, Bouter LM, Lips P: Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol 1996;143:1129–1136.
  6. Harvan JR, Cotter V: An evaluation of dementia screening in the primary care setting. J Am Acad Nurse Pract 2006;18:351–360.
  7. Mahoney JE, Shea TA, Przybelski R, Jaros L, Gangnon R, Cech S, Schwalbe A: Kenosha county falls prevention study: a randomized, controlled trial of an intermediate-intensity, community-based multifactorial falls intervention. J Am Geriatr Soc 2007;55:489–498.
  8. Mahoney FI, Barthel DW: Functional evaluation: the Barthel Index. Md State Med J 1965;14:61–65.
  9. Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179–186.
  10. Sheikh J, Yesavage J: Geriatric depression scale (GDS): recent evidence and development of a shorter version; in Brink TL (ed): Clinical Gerontology: A Guide to Assessment and Intervention. New York, Haworth Press, 1986, pp 165–173.
  11. Stuck AE, Aronow HU, Steiner A, Alessi CA, Büla CJ, Gold MN, Yuhas KE, Nisenbaum R, Rubenstein LZ, Beck JC: A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. N Engl J Med 1995;333:1184–1189.
  12. Ware JE Jr, Sherbourne CD: The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473–483.
  13. The prevention of falls in later life. A report of the Kellogg international work group on the prevention of falls by the elderly. Dan Med Bull 1987;34(suppl 4):1–24.

    External Resources

  14. Mahoney JE, Palta M, Johnson J, Jalaluddin M, Gray S, Park S, Sager M: Temporal association between hospitalization and rate of falls after discharge. Arch Intern Med 2000;160:2788–2795.
  15. Wood SN: Generalized Additive Models: An Introduction with R. Boca Raton, FL, Chapman & Hall/CRC, 2006.
  16. Greenland S: Modeling and variable selection in epidemiologic analysis. Am J Public Health 1989;79:340–349.
  17. van Schoor NM, Smit JH, Pluijm SM, Jonker C, Lips P: Different cognitive functions in relation to falls among older persons. Immediate memory as an independent risk factor for falls. J Clin Epidemiol 2002;55:855–862.
  18. Team RDC: R: A language and environment for statistical computing. Vienna, Austria, R Foundation for Statistical Computing, 2005.
  19. Buchner DM, Larson EB: Falls and fractures in patients with Alzheimer-type dementia. JAMA 1987;257:1492–1495.
  20. van Dijk PT, Meulenberg OG, van de Sande HJ, Habbema JD: Falls in dementia patients. Gerontologist 1993;33:200–204.
  21. Chapman GJ, Hollands MA: Evidence that older adult fallers prioritise the planning of future stepping actions over the accurate execution of ongoing steps during complex locomotor tasks. Gait Posture 2007;26:59–67.
  22. Allali G, Kressig RW, Assal F, Herrmann FR, Dubost V, Beauchet O: Changes in gait while backward counting in demented older adults with frontal lobe dysfunction. Gait Posture 2007;26:572–576.
  23. Holtzer R, Verghese J, Xue X, Lipton RB: Cognitive processes related to gait velocity: Results from the Einstein aging study. Neuropsychology 2006;20:215–223.
  24. Springer S, Giladi N, Peretz C, Yogev G, Simon ES, Hausdorff JM: Dual-tasking effects on gait variability: the role of aging, falls, and executive function. Mov Disord 2006;21:950–957.

  

Author Contacts

Carey E. Gleason, PhD
Section of Geriatrics, Department of Medicine, University of Wisconsin
Madison VA GRECC, Room D4211, 2500 Overlook Terrace
Madison, WI 53705 (USA)
Tel. +1 608 256 1901, ext. 17000, Fax +1 608 280 7165, E-Mail ceg@medicine.wisc.edu

  

Article Information

Accepted: March 17, 2009
Published online: July 11, 2009
Number of Print Pages : 7
Number of Figures : 1, Number of Tables : 3, Number of References : 24

  

Publication Details

Dementia and Geriatric Cognitive Disorders

Vol. 27, No. 6, Year 2009 (Cover Date: July 2009)

Journal Editor: Chan-Palay V. (New York, N.Y.)
ISSN: 1420-8008 (Print), eISSN: 1421-9824 (Online)

For additional information: http://www.karger.com/DEM


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References

  1. Horikawa E, Matsui T, Arai H, Seki T, Iwasaki K, Sasaki H: Risk of falls in Alzheimer’s disease: a prospective study. Intern Med 2005;44:717–721.
  2. Folstein MF, Folstein SE, McHugh PR: ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  3. Anstey KJ, von Sanden C, Luszcz MA: An 8-year prospective study of the relationship between cognitive performance and falling in very old adults. J Am Geriatr Soc 2006;54:1169–1176.
  4. Tinetti ME, Speechley M, Ginter SF: Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319:1701–1707.
  5. Graafmans WC, Ooms ME, Hofstee HM, Bezemer PD, Bouter LM, Lips P: Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol 1996;143:1129–1136.
  6. Harvan JR, Cotter V: An evaluation of dementia screening in the primary care setting. J Am Acad Nurse Pract 2006;18:351–360.
  7. Mahoney JE, Shea TA, Przybelski R, Jaros L, Gangnon R, Cech S, Schwalbe A: Kenosha county falls prevention study: a randomized, controlled trial of an intermediate-intensity, community-based multifactorial falls intervention. J Am Geriatr Soc 2007;55:489–498.
  8. Mahoney FI, Barthel DW: Functional evaluation: the Barthel Index. Md State Med J 1965;14:61–65.
  9. Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179–186.
  10. Sheikh J, Yesavage J: Geriatric depression scale (GDS): recent evidence and development of a shorter version; in Brink TL (ed): Clinical Gerontology: A Guide to Assessment and Intervention. New York, Haworth Press, 1986, pp 165–173.
  11. Stuck AE, Aronow HU, Steiner A, Alessi CA, Büla CJ, Gold MN, Yuhas KE, Nisenbaum R, Rubenstein LZ, Beck JC: A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. N Engl J Med 1995;333:1184–1189.
  12. Ware JE Jr, Sherbourne CD: The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473–483.
  13. The prevention of falls in later life. A report of the Kellogg international work group on the prevention of falls by the elderly. Dan Med Bull 1987;34(suppl 4):1–24.

    External Resources

  14. Mahoney JE, Palta M, Johnson J, Jalaluddin M, Gray S, Park S, Sager M: Temporal association between hospitalization and rate of falls after discharge. Arch Intern Med 2000;160:2788–2795.
  15. Wood SN: Generalized Additive Models: An Introduction with R. Boca Raton, FL, Chapman & Hall/CRC, 2006.
  16. Greenland S: Modeling and variable selection in epidemiologic analysis. Am J Public Health 1989;79:340–349.
  17. van Schoor NM, Smit JH, Pluijm SM, Jonker C, Lips P: Different cognitive functions in relation to falls among older persons. Immediate memory as an independent risk factor for falls. J Clin Epidemiol 2002;55:855–862.
  18. Team RDC: R: A language and environment for statistical computing. Vienna, Austria, R Foundation for Statistical Computing, 2005.
  19. Buchner DM, Larson EB: Falls and fractures in patients with Alzheimer-type dementia. JAMA 1987;257:1492–1495.
  20. van Dijk PT, Meulenberg OG, van de Sande HJ, Habbema JD: Falls in dementia patients. Gerontologist 1993;33:200–204.
  21. Chapman GJ, Hollands MA: Evidence that older adult fallers prioritise the planning of future stepping actions over the accurate execution of ongoing steps during complex locomotor tasks. Gait Posture 2007;26:59–67.
  22. Allali G, Kressig RW, Assal F, Herrmann FR, Dubost V, Beauchet O: Changes in gait while backward counting in demented older adults with frontal lobe dysfunction. Gait Posture 2007;26:572–576.
  23. Holtzer R, Verghese J, Xue X, Lipton RB: Cognitive processes related to gait velocity: Results from the Einstein aging study. Neuropsychology 2006;20:215–223.
  24. Springer S, Giladi N, Peretz C, Yogev G, Simon ES, Hausdorff JM: Dual-tasking effects on gait variability: the role of aging, falls, and executive function. Mov Disord 2006;21:950–957.