Poor performance in a test of selective attention, response inhibition and stepping is associated with falls in older people
Schoene, D, Smith, ST, Delbaere, K & Lord, SR 2012, 'Poor performance in a test of selective attention, response inhibition and stepping is associated with falls in older people', Journal of Aging and Physical Activity, vol. 20. suppl. 1, pp. S186-S187.
Background: Previous studies have shown that older fallers have poorer cognitive func-tion than non-fallers. We developed a test that combines stepping with selective attentionand response inhibition to provide a functional measure that reflects complex real life scenarios. We aimed to determine whether this test discriminates between older fallers and non-fallers.
Methods: 102 older adults (79.4±4.9years) without cognitive impairment (MMSE 28.9±1.1) completed an inhibitive step task (INHIB) using an exergame device. In the centre of a computer screen (58cm) an arrow was presented pointing in one of four directions (up, down, left, right). Inside the arrow was a written word indicating a different direction. In 20 trials, participants had to step according to the word and inhibit the response indicated by the arrow’s shape. Participants also underwent a range of tests of physical and functional performance (timed up & go (TUG), alternate step (AS), 5 Sit-to-Stand (5STS), choice stepping reaction time (CSRT)) and cognitive function (Color Word Stroop test (CW-Stroop), Trails A&B, digit symbol (DS). Participants who reported one or more fallsin the past 12 months were classified as fallers.
Results: Participants who took longer to complete INHIB had fewer correct items in the CW-Stroop test (r = -0.337) and performed poorly in the other cognitive tests. (DS r = -0.393, Trails A r = 0.344, Trails B r = 0.370). These participants also had worse functional performance (TUG r = -0.457, AS r = 0.480, 5STS r = 0.438, CSRT r = 0.620). Univariate logistic regression indicated that participants who performed poorly in the INHIB were at increased odds of falls (OR = 2.90 (1.12-7.49), p = 0.028) with an overall correct classification of 73%.
Conclusions: INHIB, a test that combines stepping with selective attention and response inhibition, was able distinguish fallers from non-fallers, providing further evidence for cognitive mechanisms on fall risk in older people.