Executive Function and Falls in Older Adults: New Findings from a Five-Year Prospective Study Link Fall Risk to Cognition

Abstract

Background Recent findings suggest that executive function (EF) plays a critical role in the regulation of gait in older adults, especially under complex and challenging conditions, and that EF deficits may, therefore, contribute to fall risk. The objective of this study was to evaluate if reduced EF is a risk factor for future falls over the course of 5 years of follow-up. Secondary objectives were to assess whether single and dual task walking abilities, an alternative window into EF, were associated with fall risk. Methodology/Main Results We longitudinally followed 256 community-living older adults (age: 76.4±4.5 yrs; 61% women) who were dementia free and had good mobility upon entrance into the study. At baseline, a computerized cognitive battery generated an index of EF, attention, a closely related construct, and other cognitive domains. Gait was assessed during single and dual task conditions. Falls data were collected prospectively using monthly calendars. Negative binomial regression quantified risk ratios (RR). After adjusting for age, gender and the number of falls in the year prior to the study, only the EF index (RR: .85; CI: .74–.98, p = .021), the attention index (RR: .84; CI: .75–.94, p = .002) and dual tasking gait variability (RR: 1.11; CI: 1.01–1.23; p = .027) were associated with future fall risk. Other cognitive function measures were not related to falls. Survival analyses indicated that subjects with the lowest EF scores were more likely to fall sooner and more likely to experience multiple falls during the 66 months of follow-up (p<0.02). Conclusions/Significance These findings demonstrate that among community-living older adults, the risk of future falls was predicted by performance on EF and attention tests conducted 5 years earlier. The present results link falls among older adults to cognition, indicating that screening EF will likely enhance fall risk assessment, and that treatment of EF may reduce fall risk.

The Association of Specific Executive Functions and Falls Risk in People with Mild Cognitive Impairment and Early-Stage Dementia

“…Deficits in executive function have been identified as a particular risk factor related to an increase in falls rates [1][2][3]. Two systematic reviews showed that most studies had used the Trail Making Test (TMT) to assess executive function [1,2].…”

“…The TMT examines scanning, visuo-motor tracking, divided attention and cognitive flexibility [4], and is regarded as a standard measurement of executive function [5]. Furthermore, processing speed, abstract reasoning and attention, which are related to executive function [1][2][3], have been associated with the fate of falls. Cognitive training with a focus on executive function has recently been included in exercise studies for people with dementia [6].…”

The coefficient of friction in Parkinson�s disease gait

“…Moreover, in the loading response phase, the patients with PD exhibited increases in Area 1 that scaled with increases in cognitive decline (UPDRS1). Cognitive decline is another independent risk factor for falls (Herman et al, 2010;Mirelman et al, 2012). Gait disorders and falls are more prevalent among demented patients than non-demented subjects, and there is a direct relationship between the severity of cognitive impairment and increased gait abnormalities (Amboni et al, 2013;van Iersel et al, 2004).…”

Efeitos de um treinamento com o Nintendo® Wii sobre o equilíbrio postural e funções executivas de idosos saudáveis, um estudo clínico longitudinal, controlado e aleatorizado

“…Outros estudos mostraram que idosos com prejuízos nas funções executivas são mais suscetíveis a quedas (Holtzer et al, 2007;Alexander e Hausdorff, 2008;Mirelman et al, 2012). Em um estudo prévio, Herman et al (2010) relataram que idosos saudáveis com melhor desempenho nas funções executivas apresentavam menor probabilidade de cair quando comparados com aqueles que tiveram pontuação menor nos testes neuropsicológicos.…”

“…flexibilidade mental e memória de trabalho (Stuss et al, 2007), com repercussões negativas sobre a independência e qualidade de vida dos idosos (Yogev-Seligmann et al, 2008;Herman et al, 2010;Mirelman et al, 2012), a melhora por si só destas funções já pode ser considerada clinicamente relevante para a funcionalidade dos idosos. Estudos que utilizaram outros recursos terapêuticos como fármacos e treinamento para melhorar a função cognitiva de idosos, encontraram efeitos positivos no controle de equilíbrio e redução de quedas (Gillespie et al, 2009;Montero-Odasso et al, 2009).…”