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Mild Cognitive Impairment as a Predictor of Falls in Community-Dwelling Older People

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Objective

Incidence of falls in people with cognitive impairment with or without a formal diagnosis of dementia is estimated to be twice that of cognitively intact older adults. This study aimed to investigate whether mild cognitive impairment (MCI) is associated with falls in older people.

Setting

Community sample, Sydney Memory and Ageing Study.

Participants

A total of 419 nondemented community-dwelling adults, age 70–90 years.

Measurements

A comprehensive neuropsychological test battery measuring four cognitive domains provided classification being with or without MCI on the basis of objective published criteria. Assessments of medical, physiologic, and psychological measures were also performed. Fallers were defined as people who had at least one injurious fall or at least two noninjurious falls during a 12-month follow-up period.

Results

Of the participants, 342 (81.6%) had normal cognitive functioning, 58 (13.8%) had nonamnestic MCI, and 19 (4.5%) had amnestic MCI. People with MCI performed worse than people without MCI in measures of general health and balance. Logistic regression analyses showed that fall risk was significantly greater in people with MCI (odds ratio [OR]: 1.72, 95% confidence interval [95% CI]: 1.03–2.89). This association was mainly apparent when the analysis was restricted to those with nonamnestic MCI (OR: 1.98, 95% CI: 1.11–3.53), where the relationship was primarily explained by impaired executive functioning (OR: 1.27, 95% CI: 1.02–1.59).

Conclusion

The findings indicate that objectively defined MCI is an independent risk factor for injurious or multiple falls in a representative sample of community-dwelling older people. The presence of nonamnestic MCI, based primarily on executive function, was found to be an important factor in increasing fall risk.

Section snippets

Participants

Four hundred nineteen people age 70–90 years participated in a prospective cohort study with a 1-year follow-up for falls. Participants were randomly recruited from a cohort of 1,037 community-dwelling men and women living in Eastern Sydney and participating in Wave 1 of the Sydney Memory and Ageing Study (MAS, January 2006 to October 2007).17 There were no differences between the total cohort sample (n = 1,037) and our subsample (n = 419) on any of the medical or neuropsychological measures

MEASURES

At baseline, the participants underwent an extensive assessment on medical, physiologic, and neuropsychological measures by trained research staff.

RESULTS

The mean (SD) age of the participants was 77.8 (4.6) years; 226 (53.9%) participants were women. Detailed characteristics of the sample are shown in Table 2. On self-rated health status using a five-point scale, 362 (86.4%) participants rated their health as good, very good, or excellent. One hundred forty-one (33.7%) participants reported injurious or multiple falls. One hundred eighty-three (43.7%) reported one or more falls, of whom 105 (25.1%) reported only one fall and 78 (18.6%) reported

DISCUSSION

This study suggests that the incidence of injurious or multiple falls in people with MCI is nearly twice that of people with normal cognitive functioning. To our knowledge, this is the first longitudinal study to investigate the relationship between falls and a clearly defined classification of MCI in a representative sample of community-dwelling older people. The incidence of both MCI and falls was comparable to previous studies, supporting the representativeness of our sample and indicates

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  • Cited by (0)

    The manuscript was drafted by Dr. Delbaere and Dr. Lord. Dr. Lord, Dr. Delbaere, and Dr. Close conceived the study objectives and design. Dr. Delbaere had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors were involved with interpretation of the data and preparation of manuscript.

    This research was conducted as part of a study on Understanding Fear of Falling and Risk-taking in Older People, which has been funded by an Australian NHMRC grant 400941. Dr. Lord is currently a NHMRC Senior Principal Research Fellow. The participants in this study were drawn from the Memory and Ageing Study of the Brain and Ageing Program, School of Psychiatry, UNSW, funded by a NHMRC Program grant 350833 to Drs. Sachdev, Brodaty, and Andrews.

    The FallScreen (PPA) assessment is commercially available through Neuroscience Research Australia.

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