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Objective: We determined the rate of falls among cognitively normal, community-dwelling older adults, some of whom had presumptive preclinical Alzheimer disease (AD) as detected by in vivo imaging of fibrillar amyloid plaques using Pittsburgh compound B (PiB) and PET and/or by assays of CSF to identify Ab 42 , tau, and phosphorylated tau. Methods:We conducted a 12-month prospective cohort study to examine the cumulative incidence of falls. Participants were evaluated clinically and underwent PiB PET imaging and lumbar puncture. Falls were reported monthly using an individualized calendar journal returned by mail. A Cox proportional hazards model was used to test whether time to first fall was associated with each biomarker and the ratio of CSF tau/Ab 42 and CSF phosphorylated tau/Ab 42 , after adjustment for common fall risk factors. Results:The sample (n 5 125) was predominately female (62.4%) and white (96%) with a mean age of 74.4 years. When controlled for ability to perform activities of daily living, higher levels of PiB retention (hazard ratio 5 2.95 [95% confidence interval 1.01-6.45], p 5 0.05) and of CSF biomarker ratios (p , 0.001) were associated with a faster time to first fall. Conclusions:Presumptive preclinical AD is a risk factor for falls in older adults. This study suggests that subtle noncognitive changes that predispose older adults to falls are associated with AD and may precede detectable cognitive changes. Falls remain the leading cause of long-term disability, premature institutionalization, injury, and injury-related mortality in the older adult population.1 Persons with Alzheimer disease (AD) dementia have an increased risk of serious falls.2 Gait changes and falls have been associated with non-AD dementias.3 However, gait change may also be associated with AD and may precede cognitive changes.4,5 New guidelines and diagnostic criteria for AD 6 now recognize a preclinical phase of the disease, detectable with imaging and CSF biomarkers. 7 There are hypothesized models of ordered change in validated biomarkers that occur during the AD process.8 Only limited data have been available to indicate that cognitively normal older adults with positive AD biomarkers of presumptive preclinical AD are at increased risk of developing cognitive impairment and dementia.9,10 However, a stage of preclinical AD has been validated by AD biomarkers in asymptomatic individuals who carry a deterministic mutation for AD.11 By definition, older adults with presumptive preclinical AD do not have cognitive symptoms as recognized by current clinical methods. However, other changes may be detectable and could yield important information about the spectrum of clinical features of the disease. Physical changes such as weight loss 12 and frailty 13 have been identified in cognitively normal individuals who later develop AD dementia. Because motor slowing precedes cognitive impairment during the typical From the Program in Occupational Therapy (S.L.S., H.H., J.C.M.), and

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The FABS/M includes 61 questions, 133 items and six domains including the type of primary mobility device; built features of homes; built and natural features in the community; community destination access; community facilities access; community support network. Environmental items are scored for the frequency of encounter and the magnitude of influence on their participation. The internal consistencies and the test-retest reliabilities of the domains of the FABS/M ranged from low to moderate. The discriminant validity of domains differed for device and diagnostic groups. CONCLUSION. The FABS/M joins the MQE and the CHIEF as another subjective measure for use in assessing environmental features important for understanding participation. The FABS can be used to assess the influence of environmental interventions at the individual and community levels of analysis. The type of primary mobility device that is used can be related to reported environmental barriers. Community-based improvements in built features, access to destinations, access to facilities and augmented support networks can be tracked through the reports of people with mobility impairments.

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Objectives To describe methods used in operationalizing environmental factors; to describe the results of a research project to develop measures of environmental factors that affect participation; and to define an initial item set of facilitators and barriers to participation after stroke, traumatic brain injury, and spinal cord injury. Design Instrument development included an extensive literature review, item classification and selection, item writing, and cognitive testing following the approach of the Patient-Reported Outcomes Measurement Information System. Setting Community. Participants Content area and outcome measurement experts (n=10) contributed to instrument development; individuals (n=200) with the target conditions participated in focus groups and in cognitive testing (n=15). Interventions None. Main Outcome Measures Environmental factor items were categorized in 6 domains: assistive technology; built and natural environment; social environment; services, systems, and policies; access to information and technology; and economic quality of life. Results We binned 2273 items across the 6 domains, winnowed this pool to 291 items for cognitive testing, and recommended 274 items for pilot data collection. Conclusions Five of the 6 domains correspond closely to the International Classification of Functioning, Disability and Health taxonomy of environmental factors; the sixth domain, economic quality of life, reflects an important construct that reflects financial resources that affect participation. Testing with a new and larger sample is underway to evaluate reliability, validity, and sensitivity.

OBJECTIVE. The goal was to develop an objective, comprehensive, near-task home lighting assessment for older adults with low vision. METHOD. A home lighting assessment was developed and tested with older adults with low vision. Interrater and test–retest reliability studies were conducted. Clinical utility was assessed by occupational therapists with expertise in low vision rehabilitation. RESULTS. Interrater reliability was high (intraclass correlation coefficient [ICC] = .83–1.0). Test–retest reliability was moderate (ICC = .67). Responses to a Clinical Utility Feedback Form developed for this study indicated that the Home Environment Lighting Assessment (HELA) has strong clinical utility. CONCLUSION. The HELA provides a structured tool to describe the quantitative and qualitative aspects of home lighting environments where near tasks are performed and can be used to plan lighting interventions. The HELA has the potential to affect assessment and intervention practices of rehabilitation professionals in the area of low vision and improve near-task performance of people with low vision.