Outcome Measures for Mild Balance and Cognitive Decline in a Pre-Old Adult: A Case Report

Abstract

Background and Purpose. Early detection and treatment of age-related decline, particularly balance and cognition, are increasingly being emphasized in current research. However, the majority of research on older adults focuses on participants who are 65 years and older. For individuals who are 60-64 years old, this is an age range where they may or may not be considered an older adult. This poses a problem applying the results of these studies to pre-old adults to accurately diagnose, measure and classify risk in the areas of cognition and balance. Case Description. The patient is a 61-year-old woman with a clinical diagnosis of osteoporosis. She has had 5 falls and near-falls in the past year. She also experiences memory problems, which sometimes affects her ability to plan and organize her schedule. She is otherwise well, with no limits to participation. Outcomes Assessment. Frequently used clinical tools to assess for mild balance and cognitive deficits were performed in order to detect diagnosis and/or classify risk. A total of 14 tools related to balance and falls, and 4 tools related to cognition were chosen. Results. Of the assessment tools used, only the Mini Balance Evaluation Systems Test (Mini BESTest), High Level Mobility Assessment Test (HiMAT), and the Falls Efficacy Scale- International (FES-I) were able to identify and classify risk of fall and/or balance deficits. Of the cognitive tools performed, only the Montreal Cognitive Assessment (MoCA) produced abnormal results, suggesting cognitive decline. Conclusions. Many of the frequently used clinical assessment tools were unable to identify falls history and balance deficits in this patient. In view of the lack of sensitivity in balance assessment tools in pre-old adults and the multiple factors associated with falls risk, it is difficult to conclusively determine if she does have balance deficits and to quantify her risk of future falls. Cognitive screening in this patient suggests that an algorithmic approach using the Mini Mental State Examination (MMSE) and the MoCA may be effective in screening for mild cognitive impairment (MCI). More research should be directed towards the development and validation of sensitive instruments to detect mild balance deficits and screening for MCI, especially in the pre-old adult.