Thursday, 28 February 2013

Cognitive slowing and falls

EpubSosnoff et al. Cognitive Processing Speed is Related to Fall Frequency in Older Adults with Multiple Sclerosis. Arch Phys Med Rehabil. 2013 Feb 16. doi:pii: S0003-9993(13)00134-2. 10.1016/j.apmr.2013.02.009. 

OBJECTIVE: To examine mobility, balance, fall risk and cognition in older adults with multiple sclerosis (MS) as a function of fall frequency.


DESIGN: Retrospective, cross-sectional design.


SETTING: University research laboratory.


PARTICIPANTS: Community dwelling persons with MS (N=27) aged between 50 and 75 years were divided into two groups (single (n=11) and recurrent fallers (n=16; > 2 falls/12 months)) based on previous falls history.


INTERVENTION: Not Applicable.


MAIN OUTCOME MEASURES: Mobility was assessed using a variety of measures including, Multiple Sclerosis Walking Scale-12 (MSWS-12), walking speed (Timed 25 Foot Walk), endurance (6-Minute Walk) and functional mobility (Timed Up and Go). Balance was assessed with the Berg Balance Scale, posturography and self-reported balance confidence. Falls risk was assessed with the Physiological Profile Assessment (PPA). Cognitive processing speed was quantified with the symbol digit modalities test (SDMT) and the paced auditory serial addition test (PASAT).


RESULTS: Recurrent fallers had slower cognitive processing speed than single fallers (p's ≤ .01). There was no difference in mobility, balance or fall risk between recurrent and single fallers (p's > .05).


CONCLUSIONS: Results indicated that cognitive processing speed is associated with fall frequency and may have implications for fall prevention strategies targeting recurrent fallers with MS.


This is a relatively small study, but covers something that I have become increasingly interested in - how to predict and (more importantly) prevent falls. Unfortunately resources are limited, and an effective falls prevention strategy needs to be directed at those who will most benefit from this - i.e. those who are most likely to fall. In addition, any falls prevention strategy needs to be designed to best benefit those who are using it. 

The finding that recurrent fallers have a slower cognitive processing is not a new one (see here and here). However, the lack of an effect of poor balance and mobility is in contrast to other larger studies. We also have data from the MS clinic here regarding the Berg Balance Scale and self-reported balance confidence in a larger group of people with MS (99 people) which is in contrast to these findings - they do seem to predict falls risk, albeit imperfectly. 

The most striking thing about the falls literature is the fact that a large number of falls go unreported. Maybe this is learned helplessness, in that our falls strategies are not working, but it is something that we need to improve. If you are falling, then please tell your neurologist about it! It is difficult to highlight deficiencies and campaign for appropriate changes in the system without having the clinical data to back this up. 

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