Scientists have found a link between dementia risk and falls in older adults.
- Older adults who have experienced a traumatic
injury as a result of falling are 21 percent more likely to later receive
a diagnosis of Alzheimer’s disease or another related dementia.
- A new study examined data from more than 2
million older adults who had sustained a traumatic injury; more than 10
percent of them later received a diagnosis of some form of dementia.
- Experts say pinpointing the direct association
with falls and dementia is difficult, but suggest that older adults who
have been hospitalized as a result of a fall should undergo cognitive
testing.
Older adults who have experienced a traumatic
injury as a result of falling are more than 20 percent likely to later receive
a diagnosis of Alzheimer’s disease or another related dementia,
according to a new study published in JAMA Network Open.
The retrospective cohort study, conducted
by researchers at Brigham and Women’s Hospital, a founding member of the Mass
General Brigham healthcare system, examined data from more than 2 million older
adults who had sustained a traumatic injury. More than 10 percent of them later
received a diagnosis of some form of dementia in the year after their fall.
From the study cohort, the average age of
patients who experienced a fall was 78; more women fell than men. In general,
adults over 65 who sustain traumatic injury after a fall are more subject to
already developing cognitive decline.
Some types of dementia, such as Alzheimer’s
disease, result from the progressive death of brain cells and neurons. It develops and worsens over time.
But head injuries can contribute to dementia through the damage to cells
directly. Some types of traumatic brain injury — particularly if repetitive,
which can happen in some sports — may increase the risk of certain types of dementia later in
life.
How do falls
contribute to Alzheimer’s or dementia?
A loss of motor skills is part of the
progression of Alzheimer’s disease in general. People may have difficulty with
their balance, trip over, or spill things more often, or they may have
difficulty orienting clothing to their body when getting dressed.
In a press release, senior author Molly Jarman, PhD, MPH, assistant professor in the Department of
Surgery and deputy director of the Center for Surgery and Public Health at
Brigham, said the connection between falling and the development of any
cognitive disease can be a “two-way street.”
However, Alexander Ordoobadi, MD, a resident physician in the Department of
Surgery at Brigham and Women’s Hospital and first author of the study,
told Medical News Today that the study’s results couldn’t
provide a direct association between falls and dementia.
“Some of the patients may have had some
degree of mild cognitive impairment at the time of the fall and subsequently
progressed to develop dementia over the course of the year after the fall.
Other patients may have had dementia at the time of the fall that had gone
undiagnosed prior to the fall and was formally diagnosed in the aftermath of
the fall due to increased exposure to the healthcare system,” Ordoobadi said.
“We think that it is less likely that the
trauma from the fall itself is leading to dementia, since the risk of
developing dementia was lower after other types of injury. Either way, the
results of our study highlight that all older adults who are hospitalized
because of a fall should undergo cognitive screening to aid in the early
diagnosis of dementia,” he said.
Clifford Segil, DO, neurologist at Providence Saint John’s Health Center
in Santa Monica, CA, who was not involved in the study, gave MNT a
similar view.
“It is challenging to assign how a
ground-level fall could worsen dementia, which is a complicated disease process
unless the fall caused bruising in an older person’s brain in the form of a
subdural hematoma or another type of brain bruise,” Segil said., but added that
certain types of dementia such as lewy body dementia or Parkinson’s dementia
may increase the risk of falls.
Do other
medical conditions make dementia more likely after a fall?
Ordoobadi said that any decline in
cognition can affect motor skills, and mild declines are precursor conditions
to more serious forms of dementia.
“Walking requires substantial cognitive
capacity to coordinate motor movements, maintain balance, and safely navigate
the environment. Impairments in motor domains involving gait often precedes the
formal diagnosis of dementia and would place patients at risk for falling,”
Ordoobadi said.
“We think that many of
the patients who experienced a fall and subsequently were diagnosed with
dementia in the year after the fall may have had mild cognitive impairment—a
precursor condition to dementia—at the time of the fall. This would place
patients at risk both for falling and for developing dementia.”
— Alexander Ordoobadi, MD
Segil said that a number of conditions
associated with aging can result in falls, which, again, can be linked to the
development of dementia but can also be a sign of it.
“Older patients often have medical
comorbidities making them fall risks which are extremely varied and common.
Heart disease can make some pass out or having a syncopal episode. Diabetes can
cause neuropathy, causing people to be unsteady and fall. Parkinson’s Disease
may cause unsteadiness due to a tremor or stiffness,” Segil explained.
“Only some of these can result in increased
dementia. Movement disorder patients who fall may be at risk for Lewy Body
Dementia. Stroke patients who fall may be at risk for vascular dementia or
multi-infarct dementia,” he said.
Segil added that he would be “in support of
advising patients with ground-level falls to obtain a simple outpatient
cognitive screening with something like a mini-mental status exam as the data
is convincing that patients with frequent falls are at a point in their lives
when this screening would be valuable.”
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