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Session: Movement Sensing - Balance - Fall Detection
Session starts: Friday 25 January, 10:30
Presentation starts: 11:00
Room: Lamoraalzaal

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Marjon Stijntjes (Department of Gerontology and Geriatrics, Leiden University Medical Center)
Jantsje Pasma (Department of Rehabilitation Medicine, Leiden University Medical Center)
Astrid Bijlsma (Department of Gerontology and Geriatrics, Leiden University Medical Center)
Marjet van Vuuren (Department of Gerontology and Geriatrics, Leiden University Medical Center)
Carolien Jurgens (Department of Geriatrics, Bronovo Hospital)
Marie-Noëlle Witjes-Ané (Department of Geriatrics, Bronovo Hospital)
Gerard Jan Blauw (Department of Geriatrics, Bronovo Hospital)
Carel Meskers (Department of Rehabilitation Medicine, Leiden University Medical Center)
Andrea Maier (Department of Internal Medicine, Section of Gerontology and Geriatrics, VU University Medical Center)

Abstract:
Background: Impaired balance control is one of the main risk factors for falls in elderly resulting in loss of independence. The association with cognitive performance is of direct clinical interest. We aimed to establish the association of cognitive performance with common measures of balance control in elderly with mobility impairments. Methods: Cross-sectional study design consisting of 197 patients (mean age (SD) 81.9 (7.1) years) who were referred to the geriatric outpatient clinic for reason of mobility impairments. Actual physical performance was assessed extensively using common clinical tests. Cognitive performance was assessed by Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Visual Association Test (VAT). The group of patients was dichotomized into a group with low cognitive performance (MMSE < 24 points, MoCA < 23 points and VAT < 3 points based on clinically used cut off values) and normal cognitive performance. The ability to maintain ten seconds of quiet stance was tested in side-by-side, semi-tandem and tandem stance, with eyes open and eyes closed. Measurements were performed on a six degrees of freedom force plate to assess Center of Pressure (CoP) movement. Data were analyzed with logistic and linear regression adjusted for age, gender and education. Results: Short Physical Performance Battery score was (median (interquartile range)) 7 (5-10) out of 12 points and preferred gait speed (mean (SD)) 0.87 (0.29) meters per second. Patients with a low cognitive performance were less able to maintain quiet stance during side-by-side stance with eyes closed compared to the group with normal cognitive performance. This result was consistently found for MMSE (95% confidence interval (CI) 1.17–6.78), MoCA (95% CI 1.17–8.21) and VAT (95% CI 1.02–5.96). Additionally, patients with a low MMSE score were less able to maintain quiet stance during the semi-tandem stance with eyes open (95% CI 1.16–6.86). Cognitive performance was not associated with measures of CoP movement for all test conditions. Conclusions: In elderly with mobility impairments, low cognitive performance is associated with the ability to maintain quiet stance, especially in conditions without visual control of balance. Confirmation of the clinical importance and absence of the association with measures of CoP movement underlines the urgency for quantitative and causal assessment of the role of cognitive performance in balance control in a clinical setting.