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

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.

Quantitative Mobility Assessment for Fall Risk Prediction in Dementia: A Systematic Review

“…Study design varied across articles (see Table 2): 3 studies were cross-sectional with one baseline assessment [31,32,38], 9 studies involved a gait/balance assessment at baseline (also cross-sectional) with a follow-up for up to 2, 3, 4, 5, 12, or 24 months to record occurrence of fall incidents [2,12,13,24,26,32,[34][35][36][37], and 2 studies included repeated gait and balance data collection throughout the follow-up period [23,39]. One study [29] collected gait and balance measures at baseline and captured a measure of tortuosity continuously over a 1-year period.…”

“…One study [29] collected gait and balance measures at baseline and captured a measure of tortuosity continuously over a 1-year period. Two studies included data from healthy control participants (no dementia) or participants with mild dementia in their analysis [32,38].…”

“…Two studies [37,38] included mixed settings with a majority of participants residing in the community and the remainder living in long-term care.…”

“…The type of quantitative gait and balance measures used to assess fall risk fell into two categories: (1) 7 studies included instrumented quantitative measures of gait and balance (e.g., accelerometers) [2,23,24,26,31,36,38] and (2) 5 studies included non-instrumented, performance measures (e.g., 6-min walk) [13,32,34,35,37]. A combination of instrumented and performance measures of gait and balance was used in 3 studies [12,29,39] (Table 2).…”

“…In total, 3 studies were solely based on the retrospective history of falls (prior to baseline performance measurement) [31,32,38] and the remaining 12 studies used prospective falls data. Five studies used both retrospective and prospective fall information for their analysis [2,12,13,23,24,26,29,[34][35][36][37]39].…”