Executive Functions Are Associated with Fall Risk but not Balance in Chronic Cerebrovascular Disease

Abstract

Background: Older people’s deficits in executive functions (EF) have been shown to lead to higher fall risk, postural sway, and reduced speed. Crucially, EF impairments are even more pronounced in individuals with chronic cerebrovascular disease (CVD), namely vascular cognitive impairment. Methods: In this retrospective cross-sectional study, we used a complete neuropsychological battery, including the Trail Making Test (TMT) and physical measures, such as the Morse fall and EQUI scales, to assess 66 individuals with chronic CVD. Linear regressions, Bayesian analyses, and model selection were performed to see the impact of EF, global cognition, and vascular parkinsonism/hemiplegia on physical measures (fall risk and balance). Results: The TMT part B and BA correlated (r = 0.44 and r = 0.45) with Morse fall scale. Only EF significantly explained fall risk, whereas global cognition and vascular parkinsonism/hemiplegia did not. These findings were confirmed by Bayesian evidence and parsimony model selection. Balance was not significantly correlated with any of the neuropsychological tests. Conclusions: This is the first study investigating the relationship between cognitive and physical measures in a sample of older people with chronic CVD. The results are consistent with previous findings that link EF with fall risk in CVD.

Synergistic associations of cognitive and motor impairments with functional outcome in covert cerebral small vessel disease

“…Recently, associations between measures of motor and cognitive abilities have been reported in older individuals with atrial fibrillation, although these relationships were not related to cerebral lesion burden [42]. In chronic cerebrovascular disease, executive functions, but not global cognition, has been associated with risk of falls, while balance had no correlations with neuropsychological measures [43].…”

Technology-Assisted Cognitive Motor Dual-Task Rehabilitation in Chronic Age-Related Conditions: Systematic Review

“…The risk of cognitive and motor decline is high in healthy, frail, and multimorbid older adults (>65 years) and people living with dementia [15][16][17][18][19][20]. In addition, normal and pathological aging are characterized by a decline in dual-task ability [8,10,20].…”

“…This reduced ability can have serious consequences (eg, falls and injuries) for older adults [2]. Parallel to this, older adults aged ≥65 years with and without frailty or chronic diseases (eg, multimorbidity and dementia) are at great risk for falls and cognitive decline [15][16][17][18][19][20].…”

Synergistic associations of cognitive and motor impairments with functional outcome in covert cerebral small vessel disease

“…17 In chronic cerebrovascular disease, executive functions, but not global cognition, has been associated with risk of falls, while balance had no correlations with neuropsychological measures. 16 The role of WMH in old-age disability in terms of impaired IADL has been well documented. 3 We observed both WMH and GM volumes to be associated with IADL as evaluated with a validated questionnaire by the patient's close informant.…”

“…A recent retrospective study has reported executive functions, but not global cognition, to be associated with risk of falls in patients with chronic cerebrovascular disease, but it did not demonstrate any relationship between measures of cognition and balance. 16 Another study has found an association between mobility and cognitive performance independently of cerebral lesion burden among older patients with atrial fibrillation. 17 This study investigated the relationships and functional significance of cognitive and motor abilities in older individuals with different degrees of WMH by using standard physical and neuropsychological assessments and quantitative evaluation of brain changes on structural MRI.…”