Increased risk for falling associated with subtle cognitive impairment: secondary analysis of a randomized clinical trial.
Increased risk for falling associated with subtle cognitive impairment: secondary analysis of a randomized clinical trial.
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DOI：
10.1159/000228257
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发表时间：
2009
影响因子：
2.4
通讯作者：
Mahoney JE
中科院分区：
文献类型：
--
作者：
Gleason CE;Gangnon RE;Fischer BL;Mahoney JE
痴呆症会增加患者意外跌倒的风险。然而，尚不清楚轻度认知缺陷是否也会增加跌倒的风险。这项研究试图澄清细微的认知障碍，通过广泛使用的、基于临床的评估--简易精神状态检查(MMSE)--与跌倒风险之间的关系。在基诺沙县预防跌倒研究的第二次分析中，我们对172名随机进入对照组的受试者进行了二次分析，这是一项针对有跌倒风险的老年人的随机对照试验，我们检查了172名随机进入对照组的受试者中，基线MMSE与12个月预期跌倒发生率之间的关系。单因素分析显示，跌倒发生率随简明精神状态量表评分每单位下降至少22分而增加(比率比1.25，95%可信区间1.09~1.45，p=0.0026)。经逐步多元回归分析，控制日常生活活动能力、辅助设备的使用、目前的运动情况和关节炎后，MMSE评分与跌倒发生率之间的关联仍然存在(RR1.20，95%CI1.03~1.40，p=0.021)。MMSE的微小下降与跌倒速度的上升有关，这表明MMSE得分高于与痴呆症诊断一致的临界值反映的细微认知缺陷可能会影响跌倒的风险。
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. 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. Using univariate analysis, rate of falls increased with each unit decrease in MMSE score down to at least 22 (rate ratio 1.25, 95% 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 (RR 1.20, 95% CI 1.03–1.40, p=0.021). 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.