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Simpkins C, Khalili SM, Yang F. Meta-Analysis-Based Comparison of Annual Fall Risk between Older Adults with Alzheimer's Disease and Mild Cognitive Impairment. ADVANCES IN GERIATRIC MEDICINE AND RESEARCH 2024; 6:e240002. [PMID: 38725433 PMCID: PMC11081206 DOI: 10.20900/agmr20240002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Background Falls are a primary cause of injuries and hospitalization in older adults. It has been reported that cognitive impairments and dementia can increase fall risk in the older population; however, it remains unknown if fall risk differs among subgroups of dementia. This meta-analysis summarized previous studies reporting the annual fall risk of people with Alzheimer's disease (AD) or mild cognitive impairment (MCI) and compared the fall risk between these two groups of people with dementia. Methods Thirty-five studies enrolling 7844 older adults with AD or MCI were included. The annual fall prevalence and average number of falls of the included studies were meta-analyzed and compared by random-effects models with inverse variance weights. Results The annual fall prevalence in people with AD (43.55%) was significantly higher than MCI (35.26%, p < 0.001). A χ2 test indicated that the pooled fall prevalence is significantly higher in people with AD than MCI χ2 = 158.403, p < 0.001). Additionally, the yearly average number of falls in AD was higher than in MCI (1.30 vs 0.77 falls/person). Conclusions The results showed that older people with AD experience a higher annual fall prevalence with a larger number of falls than older adults with MCI. The results suggested that the fall risk measurements should be reported separately between people with AD and MCI. The findings could provide preliminary guidance for the identification of individuals with dementia who experience a high fall risk.
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Affiliation(s)
- Caroline Simpkins
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
- These authors contributed equally
| | - Sara Mahmoudzadeh Khalili
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
- These authors contributed equally
| | - Feng Yang
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
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Bueno GAS, do Bomfim AD, Campos LF, Martins AC, Elmescany RB, Stival MM, Funghetto SS, de Menezes RL. Non-invasive neuromodulation in reducing the risk of falls and fear of falling in community-dwelling older adults: systematic review. Front Aging Neurosci 2024; 15:1301790. [PMID: 38516635 PMCID: PMC10956576 DOI: 10.3389/fnagi.2023.1301790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/29/2023] [Indexed: 03/23/2024] Open
Abstract
Introduction Neuromodulation is a non-invasive technique that allows for the modulation of cortical excitability and can produce changes in neuronal plasticity. Its application has recently been associated with the improvement of the motor pattern in older adults individuals with sequelae from neurological conditions. Objective To highlight the effects of non-invasive neuromodulation on the risk of falls and fear of falling in community-dwelling older adults. Methods Systematic review conducted in accordance with the items of the Cochrane Handbook for Systematic Reviews of Interventions. Searches were carried out in electronic databases: CENTRAL, Clinical Trials, LILACS, PEDro, PubMed, Web of Science, between 13/06/2020 and 20/09/2023, including all indexed texts without language and publication date restrictions, randomized controlled clinical trials, which presented as their main outcome non-invasive neuromodulation for reducing the fear of falling and risk of falls in the older adults, regardless of gender. Results An extensive search identified 9 eligible studies for qualitative synthesis from 8,168 potential articles. Rigorous filtering through automated tools, title/abstract screening, and full-text evaluation ensured a focused and relevant selection for further analysis. Most studies (80%) used transcranial direct current electrical stimulation as an intervention, over the motor cortex or cerebellum area, with anodal current and monopolar electrode placement. The intensity ranged from 1.2 mA to 2 mA, with a duration of 20 min (80%). The profile of the research participants was predominantly individuals over 65 years old (80%), with a high risk of falls (60%) and a minority reporting a fear of falling (40%). The outcomes were favorable for the use of neuromodulation for the risk of falls in the older adults, through improvements in static and dynamic balance. Conclusion The results may have limited applicability to direct outcomes related to the risk of falls, in addition to evidence regarding the difference or lack thereof in applicability between genders, fallers and non-fallers, as well as older adults individuals with low and high fear of falling. Systematic review registration The protocol for this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) to obtain the identification of ongoing research (ID: 222429).
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Affiliation(s)
- Guilherme Augusto Santos Bueno
- Department of Medicine, Centro Universitário Euro Americano, Brasilia, Brazil
- Postgraduate Program in Health Sciences and Technologies, University of Brasilía, Brasilia, Brazil
| | | | - Lorrane Freitas Campos
- Postgraduate Program in Health Sciences and Technologies, University of Brasilía, Brasilia, Brazil
| | | | | | - Marina Morato Stival
- Postgraduate Program in Health Sciences and Technologies, University of Brasilía, Brasilia, Brazil
| | | | - Ruth Losada de Menezes
- Postgraduate Program in Health Sciences and Technologies, University of Brasilía, Brasilia, Brazil
- Postgraduate Program in Health Sciences, Federal University of Goiás, Goiânia, Brazil
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van der Velpen IF, Vlasov V, Evans TE, Ikram MK, Gutman BA, Roshchupkin GV, Adams HH, Vernooij MW, Ikram MA. Subcortical brain structures and the risk of dementia in the Rotterdam Study. Alzheimers Dement 2023; 19:646-657. [PMID: 35633518 DOI: 10.1002/alz.12690] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/05/2022] [Accepted: 04/10/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Volumetric and morphological changes in subcortical brain structures are present in persons with dementia, but it is unknown if these changes occur prior to diagnosis. METHODS Between 2005 and 2016, 5522 Rotterdam Study participants (mean age: 64.4) underwent cerebral magnetic resonance imaging (MRI) and were followed for development of dementia until 2018. Volume and shape measures were obtained for seven subcortical structures. RESULTS During 12 years of follow-up, 272 dementia cases occurred. Mean volumes of thalamus (hazard ratio [HR] per standard deviation [SD] decrease 1.94, 95% confidence interval [CI]: 1.55-2.43), amygdala (HR 1.66, 95% CI: 1.44-1.92), and hippocampus (HR 1.64, 95% CI: 1.43-1.88) were strongly associated with dementia risk. Associations for accumbens, pallidum, and caudate volumes were less pronounced. Shape analyses identified regional surface changes in the amygdala, limbic thalamus, and caudate. DISCUSSION Structure of the amygdala, thalamus, hippocampus, and caudate is associated with risk of dementia in a large population-based cohort of older adults.
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Affiliation(s)
- Isabelle F van der Velpen
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Vanja Vlasov
- Interventional Neuroscience Group, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Belvaux, Luxembourg
| | - Tavia E Evans
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Mohammad Kamran Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Boris A Gutman
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Gennady V Roshchupkin
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Hieab H Adams
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Latin American Brain Health (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Mohammad Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Brognara L, Mafla-España MA, Gil-Molina I, Castillo-Verdejo Y, Cauli O. The Effects of 3D Custom Foot Orthotics with Mechanical Plantar Stimulation in Older Individuals with Cognitive Impairment: A Pilot Study. Brain Sci 2022; 12:brainsci12121669. [PMID: 36552129 PMCID: PMC9775314 DOI: 10.3390/brainsci12121669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Recent scientific evidence supports the idea that foot plantar stimulation increases the functional connectivity of brain regions involved in visuo-spatial and sensory-motor integration. In this before−after, non-randomised intervention study we assessed the change in several gait and postural parameters using inertial sensor measurements after acute plantar stimulation using custom 3D-printed insoles. The pilot study was performed on 22 institutionalised, older individuals with a high comorbidity burden who either walked autonomously or with the help of a cane. The intensity of the effects in the first mechanical plantar stimulation session (at one week) strongly predicted a change in the 180° turn duration (p < 0.05) and the standard deviation of the step duration (p < 0.05) during the timed up-and-go test. Based on these effects, researchers also predicted decreases in some postural parameters such as the root mean square of displacement on the anterior−posterior axis (p < 0.01). Thus, these preliminary findings provide a strong rationale for performing controlled clinical trials with larger samples to investigate the efficacy and mechanisms of mechanical plantar stimulation in frail elderly individuals.
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Affiliation(s)
- Lorenzo Brognara
- Department of Biomedical and Neuromotor Science, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy
- Correspondence:
| | - Mayra Alejandra Mafla-España
- Frailty and Cognitive Impairment Organized Group, University of Valencia, 46010 Valencia, Spain
- Department of Nursing, University of Valencia, Jaume Roig s/n, 46010 Valencia, Spain
| | | | | | - Omar Cauli
- Frailty and Cognitive Impairment Organized Group, University of Valencia, 46010 Valencia, Spain
- Department of Nursing, University of Valencia, Jaume Roig s/n, 46010 Valencia, Spain
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Hopkins J, Hill K, Jacques A, Burton E. Prevalence, risk factors and effectiveness of falls prevention interventions for adults living with Mild Cognitive Impairment in the community: A systematic review and meta-analysis. Clin Rehabil 2022; 37:215-243. [PMID: 36189497 DOI: 10.1177/02692155221129832] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify falls prevalence, falls risk factors and evaluate the effectiveness of falls prevention interventions for community-dwelling people with Mild Cognitive Impairment. DATA SOURCES Peer-reviewed articles (inception to 4 August 2022) from PubMed, CINAHL, PsycInfo, EMBASE, Scopus, SportDiscus and the Cochrane library. REVIEW METHODS All types of methodological approaches were considered. Inclusion criteria were community-dwelling; diagnosis of Mild Cognitive Impairment; aged 50+ years. Interventions needed to include falls prevention programs aiming to reduce falls and/or risk of falls. Outcomes of interest included number and/or rate of falls, falls prevalence and falls risk factors. For controlled trials, any control group was included. Quality assessment was completed using Cochrane's Risk of Bias Tool for randomized controlled trials and the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields for all other studies. Where statistical data pooling was not possible, narrative synthesis was used to present data in tables and figures. RESULTS Forty-seven studies were included. Prevalence of falls was 43% when data were gathered prospectively for 12 months. Confirmed falls risk factors included slow gait, dual-tasking, postural control and non-amnesic Mild Cognitive Impairment. Few studies evaluated interventions to reduce falls. Six meta-analyses were conducted, no significant reduction in falls was found. CONCLUSIONS Until further high-quality, adequately powered studies are available to guide practice, best practice guidelines recommend balance training as a core component of falls prevention programs for older people generally, as well as people with Mild Cognitive Impairment.
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Affiliation(s)
- Jane Hopkins
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia
| | - Keith Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Angela Jacques
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia.,Institute for Health Research, 3431University of Notre Dame Australia, Fremantle, WA, Australia
| | - Elissa Burton
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia.,enAble Institute, 1649Curtin University, Perth, WA, Australia
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