Reaction Time and Postural Sway Modify the Effect of Executive Function on Risk of Falls in Older People with Mild to Moderate Cognitive Impairment

Taylor, Morag E.; Lord, Stephen R.; Delbaere, Kim; Kurrle, Susan E.; Mikolaizak, A. Stefanie; Close, Jacqueline C.T. · 2017 · Crossref

DOI: 10.1016/j.jagp.2016.10.010

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Summary

This study investigates the relationship between cognitive performance and fall risk in older adults with mild to moderate cognitive impairment (CI), specifically examining whether physiological and psychological factors mediate this association. While global cognitive decline is common in this population, previous research has yielded inconsistent results regarding its direct link to falls. The authors hypothesized that executive function (EF), rather than global cognition, would be the strongest cognitive predictor of falls, and that balance and sensorimotor factors would mediate this relationship. The research utilized a secondary analysis of a prospective cohort study involving 177 community-dwelling or low-level care residents aged 60 and older with CI (defined by MMSE scores of 11–23 or ACE-R <83). Participants underwent comprehensive assessments of six neuropsychological domains (including EF, memory, and processing speed), sensorimotor function, and balance. Falls were recorded prospectively over 12 months using monthly calendars and telephone follow-ups. Statistical analyses employed Modified Poisson regression to determine relative risks (RR) and identify mediators. Participants were categorized as non-fallers (0–1 falls) or multiple fallers (2+ falls). The results indicated that poorer executive function was significantly associated with multiple falls (RR 1.50, 95% CI 1.18–1.91), whereas global cognition, memory, and language showed no significant association. Participants with poorer EF were more likely to be female, less educated, less physically active, and taking more centrally acting medications. Physiologically, this group exhibited worse vision, slower reaction times, weaker knee extension strength, and poorer balance. Mediational analysis revealed that hand reaction time and postural sway significantly mediated the relationship between EF and fall risk. Specifically, hand reaction time alone reduced the RR of EF on multiple falls by 21%, while the combined inclusion of reaction time and postural sway reduced the RR by 31%. The study concludes that in older adults with mild to moderate CI, executive dysfunction is a key risk factor for multiple falls, distinct from global cognitive impairment. This risk is partially explained by slower reaction times and increased postural sway. These findings suggest that fall prevention strategies for cognitively impaired individuals should target these specific physiological mediators rather than focusing solely on cognitive rehabilitation. The authors recommend further research into interventions that improve functional sensorimotor reaction time and balance to reduce fall incidence in this vulnerable population.

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• cognitive impairment