Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2009;27(6):557-63.
doi: 10.1159/000228257. Epub 2009 Jul 11.

Increased risk for falling associated with subtle cognitive impairment: secondary analysis of a randomized clinical trial

Carey E Gleason  1 , Ronald E Gangnon, Barbara L Fischer, Jane E Mahoney
Affiliations
Randomized Controlled Trial

Increased risk for falling associated with subtle cognitive impairment: secondary analysis of a randomized clinical trial

Carey E Gleason et al. Dement Geriatr Cogn Disord. 2009.

Abstract

Background/aims: Having dementia increases patients' risk for accidental falls. However, it is unknown if having mild cognitive deficits also elevates a person's risk for falls. This study sought to clarify the relationship between subtle cognitive impairment, measured with a widely-used, clinic-based assessment, the Mini Mental State Exam (MMSE), and risk for falls.

Methods: In a secondary analysis of the Kenosha County Falls Prevention Study, a randomized controlled trial targeting older adults at risk for falls, we examined the association between baseline MMSE and prospective rate of falls over 12 months in 172 subjects randomized to control group.

Results: Using univariate analysis, the rate of falls increased with each unit decrease in MMSE score down to at least 22 (rate ratio 1.25, 95% confidence interval (CI) 1.09-1.45, p = 0.0026). Using stepwise multivariate regression, controlling for ability to perform activities of daily living, use of assistive device, current exercise, and arthritis, the association between MMSE score and falls rate persisted (rate ratio 1.20, 95% CI 1.03-1.40, p = 0.021).

Conclusion: Minimal decrements on the MMSE were associated with elevations in rate of falls, suggesting that subtle cognitive deficits reflected in MMSE scores above a cut-off consistent with a diagnosis of dementia, can influence risk for falls.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Estimated rate ratios for falls and 95% CIs for individual MMSE scores (relative to next highest MMSE score) down to an MMSE score of 22 based on multivariate negative binomial generalized additive regression model. (An MMSE score of 22 was the last score with more than 1 observation). In addition to MMSE score, the model includes the following covariates: score on an ADL checklist, current exercise, arthritis, and use of assistive device. Horizontal line and gray shaded region give point estimate and 95% CI for average linear effect over this range of MMSE scores.
See this image and copyright information in PMC

References

    1. Horikawa E, Matsui T, Arai H, Seki T, Iwasaki K, Sasaki H. Risk of falls in Alzheimer's disease: a prospective study. Intern Med. 2005;44:717–721. - PubMed
    1. Folstein MF, Folstein SE, McHugh PR. ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198. - PubMed
    1. Anstey KJ, von Sanden C, Luszcz MA. An 8-year prospective study of the relationship between cognitive performance and falling in very old adults. J Am Geriatr Soc. 2006;54:1169–1176. - PubMed
    1. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319:1701–1707. - PubMed
    1. Graafmans WC, Ooms ME, Hofstee HM, Bezemer PD, Bouter LM, Lips P. Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol. 1996;143:1129–1136. - PubMed

Publication types