Association of cognitive impairment and fall risk in older adults: an analytical cross-sectional study

Abstract

Background/Objectives: Falling affects up to one-third of older adults each year and poses as a major public health concern. It is one of the main causes of morbidity and mortality in the geriatric population. Many studies have suggested that poorer cognition increases fall risks but there is currently no consensus on implementing cognitive assessment routinely for patients at risk of falls. This may be due to the existing time-consuming assessment tools or the lack of trained neuropsychological health professionals to administer such tests. Cognivue however, is a validated novel cognitive screening tool that is quick to administer and requires minimal training. This study aims to correlate fall risks as determined by abnormal postural stability on the computerized dynamic posturography with cognivue scores. Especially in clinical facilities without access to the exorbitant posturography equipment, Cognivue may hence help with fall risk assessments and improve clinicians’ confidence at managing patients at risk of falls. Methods: 34 older adults who were referred to the American Institute of Balance for dizziness were recruited in this prospective, cross-analytical pilot study. All participants had unremarkable vestibular neurodiagnostic workup and as part of a comprehensive balance assessment and undertook the computerized dynamic posturography test. An additional cognitive screening test using the Cognivue was further administered and all results including social demographics and medical history were statistically analyzed for correlation. Results: Participants with cognitive impairment were almost 14 times more likely to have degraded postural stability on the sensory organization test. This significance remained even after adjusting for confounding variables such as age and relevant medical comorbidities. In this group of cognitively impaired individuals, there was a greater proportion of participants with polyneuropathy, fall and neurological history as compared with participants without cognitive impairment. Conclusion: Fall risk assessments need to be expanded to included cognitive screening routinely. The inclusion of screening tools such as Cognivue should be considered to guide clinicians with managing patients at risks of falls. Further large cohort studies may be warranted and should include correlation of Cognivue with other clinical assessments such as Time-Up and Go and Dynamic Gait Index.