Falls, Cognitive Impairment, and Gait Performance: Results From the GOOD Initiative
Falls, Cognitive Impairment, and Gait Performance: Results From the GOOD Initiative
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DOI：
10.1016/j.jamda.2016.10.008
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发表时间：
2017-04-01
影响因子：
7.6
通讯作者：
Beauchet, Olivier
中科院分区：
文献类型：
--
作者：
Allali, Gilles;Launay, Cyrille P.;Beauchet, Olivier
目的：跌倒在认知能力下降的个体中非常普遍。跌倒和认知能力下降（包括痴呆的亚型和严重程度）以及步态障碍的影响之间的复杂关系尚未得到研究。本研究旨在研究亚型（阿尔茨海默病[AD]与非AD）与认知障碍和跌倒的严重程度（从临床前痴呆到中度痴呆）之间的关系，并建立痴呆过程中跌倒与步态参数之间的关系。设计：多中心横断面研究。设定：“步态、认知与衰退”（GOOD）倡议。参与者：该研究共纳入了来自7个国家的2496名老年人（76.6±7.6岁，55.0%为女性）（1161名认知健康个体[CHI]， 529名轻度认知障碍患者[MCI]， 456名轻度痴呆患者和350名中度痴呆患者）。测量方法：在每项研究的基线时回顾性收集跌倒史。用GAITRite系统记录正常步行速度下的步态速度和步幅时间变异性。结果：阿尔茨海默病患者跌倒的发生率为50%，非阿尔茨海默病患者跌倒的发生率为64%；而在CHIs中是25%与CHI相比，只有轻度和中度非ad痴呆与跌倒风险增加有关。高步幅时间变异性与无痴呆（CHI和每个MCI亚组）和轻度非AD痴呆的老年人跌倒有关，而低步幅时间变异性与所有参与者组跌倒有关，除了轻度AD痴呆。当调整步态速度时，较高的步幅时间变异性仅与CHIs患者跌倒相关（优势比1.14；P= 0.012），而与MCI或痴呆患者无关。结论：这些发现表明，与CHIs相比，非AD而非AD痴呆与跌倒增加有关。步态参数和跌倒之间的关联也因认知状态的不同而不同，这表明导致老年痴呆患者跌倒的机制与导致跌倒的CHIs患者不同。(C) 2016 AMDA -急性和长期护理医学学会。
Objectives: Falls are highly prevalent in individuals with cognitive decline. The complex relationship between falls and cognitive decline (including both subtype and severity of dementia) and the influence of gait disorders have not been studied. This study aimed to examine the association between the subtype (Alzheimer disease [AD] versus non-AD) and the severity (from preclinical to moderate dementia) of cognitive impairment and falls, and to establish an association between falls and gait parameters during the course of dementia.Design: Multicenter cross-sectional study.Setting: "Gait, cOgnitiOn & Decline" (GOOD) initiative.Participants: A total of 2496 older adults (76.6 +/- 7.6 years; 55.0% women) were included in this study (1161 cognitively healthy individuals [CHI], 529 patients with mild cognitive impairment [MCI], 456 patients with mild dementia, and 350 with moderate dementia) from 7 countries. Measurements: Falls history was collected retrospectively at baseline in each study. Gait speed and stride time variability were recorded at usual walking pace with the GAITRite system.Results: The prevalence of individuals who fall was 50% in AD and 64% in non-AD; whereas it was 25% in CHIs. Only mild and moderate non-AD dementia were associated with an increased risk for falls in comparison with CHI. Higher stride time variability was associated with falls in older adults without dementia (CHI and each MCI subgroup) and mild non-AD dementia, whereas lower gait speed was associated with falls in all participant groups, except in mild AD dementia. When gait speed was adjusted for, higher stride time variability was associated with falls only in CHIs (odds ratio 1.14; P=.012), but not in MCI or in patients with dementia.Conclusions: These findings suggest that non-AD, but not AD dementia, is associated with increased falls in comparison with CHIs. The association between gait parameters and falls also differs across cognitive status, suggesting different mechanisms leading to falls in older individuals with dementia in comparison with CHIs who fall. (C) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.