Falls in Cognitively Impaired Older Adults: Implications for Risk Assessment And Prevention
Falls in Cognitively Impaired Older Adults: Implications for Risk Assessment And Prevention
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DOI：
10.1111/jgs.15219
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发表时间：
2018-02-01
影响因子：
6.3
通讯作者：
Speechley, Mark
中科院分区：
文献类型：
--
作者：
Montero-Odasso, Manuel;Speechley, Mark
目的 概述认知在跌倒中的作用，以及对管理和预防老年人跌倒的潜在影响。设计综述。设置针对认知在跌倒中的作用的观察性和介入性研究。参与者社区居住的老年人（65 岁及以上）。测量医学文献中回顾了衰老和神经退行性疾病中步态与认知之间的关系 强调大脑运动控制缺陷在跌倒风险中的作用。回顾了双任务步态评估作为跌倒风险标记的好处。通过改善认知的某些方面来减少跌倒的治疗方法得到了评估。结果注意力和执行功能低下与步态缓慢、不稳定和未来跌倒有关。认知增强药物可能会减少帕金森病的跌倒风险，而认知训练、双任务训练和虚拟现实模式有望改善久坐的老年人以及认知障碍和痴呆症患者的活动能力。结论跌倒在老年人中仍然很常见，认知障碍患者的患病率和发病率较高。弄清认知缺陷对跌倒风险的影响机制和影响可能会开辟新的治疗方法。越来越多的证据表明认知疗法有助于减少跌倒。
ObjectivesTo provide an overview of the role of cognition in falls, with potential implications for managing and preventing falls in older adults.DesignReview.SettingObservational and interventional studies addressing the role of cognition on falls.ParticipantsCommunity-dwelling older adults (65 years and older).MeasurementsThe relationship between gait and cognition in aging and neurodegeneration was reviewed in the medical literature to highlight the role of brain motor control deficits in fall risk. The benefits of dual-task gait assessments as a marker of fall risk were reviewed. Therapeutic approaches for reducing falls by improving certain aspects of cognition were appraised.ResultsLow performance in attention and executive function are associated with gait slowing, instability, and future falls. Drug-enhancement of cognition may reduce falls in Parkinson's disease, and cognitive training, dual-task training, and virtual reality modalities are promising to improve mobility in sedentary older adults and in those with cognitive impairment and dementia.ConclusionFalls remain common in older people, with higher prevalence and morbidity in those who are cognitively impaired. Disentangling the mechanism and contribution of cognitive deficits in fall risk may open new treatment approaches. Mounting evidence supports that cognitive therapies help reduce falls.