Reaction Time and Postural Sway Modify the Effect of Executive Function on Risk of Falls in Older People with Mild to Moderate Cognitive Impairment

2017 ◽  
Vol 25 (4) ◽  
pp. 397-406 ◽  
Author(s):  
Morag E. Taylor ◽  
Stephen R. Lord ◽  
Kim Delbaere ◽  
Susan E. Kurrle ◽  
A. Stefanie Mikolaizak ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Executive Function ◽  
Reaction Time ◽  
Older People ◽  
Postural Sway ◽  
Moderate Cognitive Impairment ◽  
Risk Of Falls

33 Cognitive Domain Associations with Balance Performance in Community – Dwelling Older People with Cognitive Impairment

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv9-iv12
Author(s):  
Morag Taylor ◽  
Stephen Lord ◽  
Annika Toots ◽  
Close Jacqueline
Keyword(s):  
Cognitive Impairment ◽  
Executive Function ◽  
Older People ◽  
Verbal Fluency ◽  
Community Dwelling ◽  
Cognitive Domain ◽  
Balance Performance ◽  
Visuospatial Ability ◽  
Community Dwelling Older People ◽  
Attention Memory

Abstract Aims Investigate the relationship between global cognition and cognitive domain function and balance performance in a large sample of older people with cognitive impairment. Methods Three hundred and nine community-dwelling older people (mean age=82 years; 47% female) with cognitive impairment were recruited for the iFOCIS fall prevention randomised controlled trial. Baseline assessments completed before randomisation were used for analyses and included the Addenbrooke’s Cognitive Examination-III (ACE-III; global cognitive function) and its individual cognitive domains (attention; memory; verbal fluency; language; visuospatial ability) and executive function, further examined using the Frontal Assessment Battery (FAB). Balance performance was derived by averaging postural sway on floor and foam, maximal balance range (reverse z-score) and co-ordinated stability z-scores. With balance performance as the dependent variable, global cognition and each cognitive domain were entered into multivariate linear regression models. Results Mean (± standard deviation) ACE-III and FAB scores were 62.8±19.2 and 11.4±4.6 respectively. In linear regression analyses adjusted for covariates, global cognitive function and each cognitive domain were significantly associated with balance performance. Executive function (verbal fluency; β=-.248, p<0.001, adjusted R2=0.376) and visuospatial ability (β=-.250, p<0.001, adjusted R2=0.381) had the strongest and memory the weakest (β=-.119, p=0.018, adjusted R2=0.334) association with balance. Visuospatial ability remained significantly associated with balance performance when adjusted for attention, memory, language, verbal fluency and the FAB. Executive function (verbal fluency) remained significantly associated with balance when adjusted for attention, memory, language and visuospatial ability. Conversely, attention, memory, and language did not withstand adjustment for visuospatial ability or executive function. Conclusions Poorer global cognition and performance in each cognitive domain were associated with poorer balance performance in this large sample of community-dwelling older people with cognitive impairment. Visuospatial ability and executive function were independently associated with balance, highlighting the role higher-level cognitive processes and spatial perception and processing play in postural control.

scholarly journals Fall Prevention in Adults With Cognitive Impairment: Systematic Review and Meta-Analysis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 698-698
Author(s):  
Megan Racey ◽  
Maureen Markle-Reid ◽  
Muhammad Usman Ali ◽  
Hélène Gagné ◽  
Susan Hunter ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Fall Prevention ◽  
Perceived Risk ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Community Dwelling ◽  
Exercise Interventions ◽  
Moderate Cognitive Impairment ◽  
Prevention Interventions ◽  
Risk Of Falls

Abstract Cognitive impairment increases an individual’s risk of falls due to the role cognition plays in gait control. Older adults with dementia fall 2-3 times more than cognitively healthy older adults and there is a lack of evidence for effective fall prevention interventions for community-dwelling cognitively impaired adults. We conducted a systematic review and meta-analysis to investigate the effectiveness of fall prevention interventions in improving falls, perceived risk of falls, gait, balance, and functional mobility. We searched 7 databases for interventions involving community-dwelling adults ≥50 years with mild to moderate cognitive impairment. Reviewers screened citations, extracted data, assessed risk of bias and certainty of evidence (GRADE). We performed a meta-analysis of 509 community-dwelling adults (mean age 67.5 to 84.0 years) with mild to moderate cognitive impairment from 12 randomized controlled trails (8 exercise interventions, 3 multifactorial, and 1 providing medication). Interventions had medium significant effects on perceived risk of falls (SMD -0.73 [-1.10, -0.36]), balance (SMD 0.66 [0.19, 1.12]), and timed up and go test (SMD -0.56 [-0.94, -0.17]) and small significant effects on gait speed and control (SMD 0.26 [0.08, 0.43]) with moderate certainty of evidence. There were no significant effects for falls. Sub-analysis showed that exercise and studies at low risk of bias remained significant for balance and perceived risk of falls. The effect of fall prevention interventions on falls remains unclear; exercise interventions are effective at addressing fall risk factors. However, high quality and longer studies with adequate sample sizes are needed to determine their effectiveness on falls.

39 A Model of Gait and Falls in Older Adults with Dementia

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv9-iv12
Author(s):  
Weihong Zhang ◽  
Lee-Fay Low ◽  
Michael Schwenk ◽  
Nicholas Mills ◽  
Josephine Diana Gwynn ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Fall Risk ◽  
Cognitive Domain ◽  
Increased Risk ◽  
Gait Dysfunction ◽  
Risk Of Falls ◽  
Fall Risks ◽  
Falls In Older Adults

Abstract Background Older people with cognitive impairment are at increased risk of falls; however, fall prevention strategies have limited success in reducing fall risks in this population (Fernando E, Fraser M, Hendriksen J et al. Physiotherapy Canada. 2017; 69: 161–170). We aim to present a model of factors contributing to gait and falls in older adults with dementia. Methods The model was developed based on an in-depth review of literature on fall risk factors particularly in people with dementia, and the relationship between cognition and gait, and their joint impact on risk of falls. Results Cognitive and motor functions are closely related as they share neuroanatomy (Rosso AL, Studenski SA, Chen WG et al. J Gerontol A Biol Sci Med Sci. 2013; 68: 1379–1386). This close relationship has been confirmed by imaging, observational and interventional studies. Executive function is the cognitive domain most commonly associated with gait dysfunction (Cohen JA, Verghese J, Zwerling JL. Maturitas. 2016; 93: 73-77). The sub-domains of executive function(Sachdev PS, Blacker D, Blazer DG et al. Neurology. 2014; 10: 634-642) - attention, sensory integration and motor planning affect risk of falls through gait dysfunction; whereas other non-gait associated sub-domains of executive function - cognitive flexibility, judgement and inhibitory control affect risk of falls through risk taking behaviour. Conclusion Gait, cognition and falls are closely related. The comoridity and interaction between gait abnormality and cognitive impairment may be the underlying mechanism behind the high prevalence of falls in older adults with dementia. Gait and cognitive assessment with particular focus on executive function, should be integrated in fall risk screening. Assessment results should inform interventions developed by a multidisciplinary team and may include strategies such as customised gait training and behavioural modulation. A comprehensive multidisciplinary approach could be more effective in reducing fall risks in older adults with dementia.

scholarly journals 160 Gait Adaptability in Older People and People with PD

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv34-iv39
Author(s):  
Stephen Lord ◽  
Joana Caetano ◽  
Jasmine Menant
Keyword(s):  
Executive Function ◽  
Older People ◽  
Muscle Power ◽  
Step Length ◽  
Quadriceps Strength ◽  
Cognitive Capacity ◽  
Cognitive Behavioural ◽  
Risk Of Falls ◽  
Reactive Balance ◽  
Step Distance

Abstract The ability to adapt gait when negotiating unexpected hazards is crucial to maintain stability and avoid falling. This presentation will present findings from a series of studies that have investigated cognitive, physical and psychological factors associated with gait adaptability required for obstacle and stepping target negotiation in older people and people with Parkinson’s disease (PD). The first studies involved fifty healthy older adults (mean±SD: 74±7 years). The gait adaptability protocol required them to either (a) avoid an obstacle at usual step distance or (b) step onto a target at either a short or long step distance projected on a walkway two heel strikes ahead and then continue walking. The primary findings were that gait adaptability was significantly associated with high risk of falls and that executive function, increased concern about falling and weaker quadriceps strength contributed significantly to this relationship. The second studies involved 54 people with PD (mean±SD: 67±67 years) who also completed the gait adaptability protocol. In this group, superior executive function, effective reactive balance and good muscle power were associated with successful gait adaptability. Furthermore, executive function and reactive balance appeared to be particularly important for precise foot placements; and cognitive capacity for step length adjustments for avoiding obstacles. These findings help elucidate mechanisms for why older people and people with PD fall. Training gait adaptability directly, as well as addressing the above associated factors through cognitive, behavioural and physical training may maximise fall prevention efficacy for these populations.

scholarly journals Understanding and managing cognitive impairment in bipolar disorder in older people

2019 ◽  
Vol 25 (3) ◽  
pp. 150-156 ◽  
Author(s):  
Judy S. Rubinsztein ◽  
Barbara J. Sahakian ◽  
John T. O'Brien
Keyword(s):  
Bipolar Disorder ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Older People ◽  
Late Onset ◽  
Treatment Options ◽  
Screening Tests ◽  
List Type ◽  
Working Age ◽  
Attention Memory

SUMMARYBipolar disorder is less prevalent in older people but accounts for 8–10% of psychiatric admissions. Treating and managing bipolar disorder in older people is challenging because of medical comorbidity. We review the cognitive problems observed in older people, explore why these are important and consider current treatment options. There are very few studies examining the cognitive profiles of older people with bipolar disorder and symptomatic depression and mania, and these show significant impairments in executive function. Most studies have focused on cognitive impairment in euthymic older people: as in euthymic adults of working age, significant impairments are observed in tests of attention, memory and executive function/processing speeds. Screening tests are not always helpful in euthymic older people as the impairment can be relatively subtle, and more in-depth neuropsychological testing may be needed to show impairments. Cognitive impairment may be more pronounced in older people with ‘late-onset’ bipolar disorder than in those with ‘early-onset’ disorder. Strategies to address symptomatic cognitive impairment in older people include assertive treatment of the mood disorder, minimising drugs that can adversely affect cognition, optimising physical healthcare and reducing relapse rates.LEARNING OBJECTIVESAfter reading this article you will be able to: •understand that cognitive impairment in euthymic older people with bipolar disorder is similar to that in working-age adults with the disorder, affecting attention, memory and executive function/processing speeds•recognise that cognitive impairment in older people is likely to be a major determinant of functional outcomes•Implement approaches to treat cognitive impairment in bipolar disorder.DECLARATION OF INTERESTB.J.S. consults for Cambridge Cognition, PEAK (www.peak.net) and Mundipharma.

scholarly journals Relationships between Gait Regularity and Cognitive Function, including Cognitive Domains and Mild Cognitive Impairment, in Community-Dwelling Older People

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1571
Author(s):  
Takasuke Miyazaki ◽  
Ryoji Kiyama ◽  
Yuki Nakai ◽  
Masayuki Kawada ◽  
Yasufumi Takeshita ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Executive Function ◽  
Mild Cognitive Impairment ◽  
Cognitive Function ◽  
Older People ◽  
Processing Speed ◽  
Vertical Component ◽  
Community Dwelling ◽  
Cognitive Domains ◽  
Community Dwelling Older People

The aim of this cross-sectional study was to examine the correlations between gait regularity, cognitive functions including cognitive domains, and the mild cognitive impairment (MCI) in community-dwelling older people. This study included 463 older adults (63.4% women, mean age: 74.1), and their step and stride regularity along the three-axis components was estimated from trunk acceleration, which was measured by inertial measurement units during a comfortable gait. Four aspects of cognitive function were assessed using a tablet computer: attention, executive function, processing speed, and memory, and participants were classified into those with or without MCI. The vertical component of stride and step regularity was associated with attention and executive function (r = −0.176–−0.109, p ≤ 0.019), and processing speed (r = 0.152, p < 0.001), after it was adjusted for age and gait speed. The low vertical component of step regularity was related to the MCI after it was adjusted for covariates (OR 0.019; p = 0.016). The results revealed that cognitive function could affect gait regularity, and the vertical component of gait regularity, as measured by a wearable sensor, could play an important role in investigating cognitive decline in older people.

scholarly journals Catch the ruler: concurrent validity and test–retest reliability of the ReacStick measures of reaction time and inhibitory executive function in older people

2018 ◽  
Vol 31 (8) ◽  
pp. 1147-1154 ◽  
Author(s):  
Kimberley S. van Schooten ◽  
Lionne Duran ◽  
Maike Visschedijk ◽  
Mirjam Pijnappels ◽  
Stephen R. Lord ◽  
...  
Keyword(s):  
Executive Function ◽  
Reaction Time ◽  
Older People ◽  
Concurrent Validity ◽  
Retest Reliability ◽  
Test Retest Reliability

Science of risk factors in fallers: impact of cognitive dysfunction

2001 ◽  
Vol 11 (4) ◽  
pp. 299-309 ◽  
Author(s):  
FE Shaw ◽  
RA Kenny
Keyword(s):  
Cognitive Impairment ◽  
Older People ◽  
Fall Risk ◽  
Cognitively Normal ◽  
The United Kingdom ◽  
Increased Risk ◽  
Risk Of Falls ◽  
The Uk ◽  
Cognitively Intact ◽  
Significant Health

Older people with cognitive impairment and dementia are at increased risk of falls and their adverse consequences when compared with cognitively intact older adults. Using prospectively gathered data, approximately three-quarters of older people with cognitive impairment and dementia can expect to fall each year, double the fall-risk of cognitively normal older people. In addition, compared with their cognitively normal counterparts, people with cognitive impairment and dementia have an increased annual incidence of fractures, and are less likely to make a good functional recovery after a fall. The prevalence of dementia in the United Kingdom is about 5% of the population aged over 65, and 15% of those aged over 80. Falls in patients with cognitive impairment and dementia represent a significant health problem in the UK.

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