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

Gilles Allali, Cyrille P. Launay, Helena M. Blumen, Michele L. Callisaya, Anne Marie De Cock, Reto W. Kressig, Velandai Srikanth, Jean Paul Steinmetz, Joe Verghese, Olivier Beauchet

Research output: Contribution to journalArticle

20 Citations (Scopus)

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.

Original languageEnglish (US)
JournalJournal of the American Medical Directors Association
DOIs
StateAccepted/In press - 2016

Fingerprint

Gait
Dementia
Alzheimer Disease
Cognitive Dysfunction
Cognition
Cross-Sectional Studies
History
Odds Ratio
Walking Speed

Keywords

  • Dementia
  • Falls
  • Gait disorders
  • Mild cognitive impairment

ASJC Scopus subject areas

  • Nursing(all)
  • Medicine(all)
  • Health Policy

Cite this

Falls, Cognitive Impairment, and Gait Performance : Results From the GOOD Initiative. / Allali, Gilles; Launay, Cyrille P.; Blumen, Helena M.; Callisaya, Michele L.; De Cock, Anne Marie; Kressig, Reto W.; Srikanth, Velandai; Steinmetz, Jean Paul; Verghese, Joe; Beauchet, Olivier.

In: Journal of the American Medical Directors Association, 2016.

Research output: Contribution to journalArticle

Allali, Gilles ; Launay, Cyrille P. ; Blumen, Helena M. ; Callisaya, Michele L. ; De Cock, Anne Marie ; Kressig, Reto W. ; Srikanth, Velandai ; Steinmetz, Jean Paul ; Verghese, Joe ; Beauchet, Olivier. / Falls, Cognitive Impairment, and Gait Performance : Results From the GOOD Initiative. In: Journal of the American Medical Directors Association. 2016.
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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.",
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AU - De Cock, Anne Marie

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AB - 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.

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