Review of Gait, Cognition, and Fall Risks with Implications for Fall Prevention in Older Adults with Dementia

Abstract

<b><i>Background:</i></b> Older people with cognitive impairment are at increased risk of falls; however, fall prevention strategies have limited success in this population. The aim of this paper is to review the literature to inform a theoretical framework for fall prevention in older adults with dementia. <b><i>Summary:</i></b> A narrative review was conducted on fall risk factors in people with cognitive impairment, the relationship between cognition and gait, and their joint impact on the risk of falls. This was used to develop a theoretical framework for fall prevention for people with dementia. Executive function and motor function are closely related as they share neuroanatomy. This close relationship has been confirmed by observational studies including neuroimaging and intervention studies. Executive function is the cognitive domain most commonly associated with gait dysfunction. Attention, sensory integration, and motor planning are the sub-domains of executive function associated with risk of falls through gait dysfunction, whereas cognitive flexibility, judgement, and inhibitory control affect risk of falls through risk-taking behaviour. <b><i>Key Messages:</i></b> Gait, cognition, and falls are closely related. The comorbidity and interaction between gait abnormality and cognitive impairment may underpin the high prevalence of falls in older adults with dementia. Gait assessment and cognitive assessment, particularly executive function, should be integrated in fall risk screening. Assessment results should be interpreted and utilised using a multidisciplinary approach; specific strategies such as customised gait training and behavioural modulation should be considered as part of falls prevention for people with dementia.

Specific Motor and Cognitive Performances Predict Falls during Ward-Based Geriatric Rehabilitation in Patients with Dementia

“…We included instrumented measures as they give a detailed insight into motor functional deficits with a high incidence of partly specific functional limitations in PwD as compared to cognitively intact peers [ 1 , 2 , 8 ], representing the highest impact factor for falls for the general population [ 72 ].…”

“…Among older persons at risk of falling, persons with dementia (PwD) or cognitive impairment (CI) represent the highest risk populations with a twice as high fall risk compared to cognitively unimpaired, and a fall incidence of 70–85% per year [ 1 , 2 ]. In institutionalized settings, fall rates are dramatic, especially so in PwD/CI, with a threefold fall risk compared to cognitively unimpaired patients [ 3 ].…”

“…Falls occur as an interaction of multiple individuum-related and environment-related risk factors [ 2 , 6 ], with fall risk drastically increasing as the number of risk factors, such as motor impairment, polypharmacy, history of falls, advancing age, female gender, and visual impairment, increases [ 6 , 7 ]. The elevated fall risk in PwD relates to disease-specific impairments of motor function, such as impaired gait, balance, and reduced functional mobility [ 1 , 2 , 8 ], as well as deficits in specific cognitive subdomains consistently related to increased fall risk, such as impaired executive function [ 9 ]. Behavioral disturbances (e.g., wandering) along with psychotropic medication [ 1 , 2 , 10 ] and lack of self-awareness for functional and cognitive impairments further contribute to fall risk in PwD [ 11 , 12 ].…”

“…The elevated fall risk in PwD relates to disease-specific impairments of motor function, such as impaired gait, balance, and reduced functional mobility [ 1 , 2 , 8 ], as well as deficits in specific cognitive subdomains consistently related to increased fall risk, such as impaired executive function [ 9 ]. Behavioral disturbances (e.g., wandering) along with psychotropic medication [ 1 , 2 , 10 ] and lack of self-awareness for functional and cognitive impairments further contribute to fall risk in PwD [ 11 , 12 ].…”

Smoothness of Gait in Healthy and Cognitively Impaired Individuals: A Study on Italian Elderly Using Wearable Inertial Sensor

“…Generally speaking, the reduction of smoothness of gait can be attributed to alterations in limb dynamics and overall function, which can be present even in the early stages of cognitive impairment [26,54], as well as in trunk stability, especially in the presence of brain structural changes such as severe white matter lesions [34]. Moreover, individuals at increased risk of falls, such as those with cognitive impairment [55,56], have difficulties in controlling the rhythmic displacements of the trunk during gait [45], which is thus another factor able to worsen the overall smoothness of gait.…”