Division of Geriatric Medicine, The University of Western Ontario, 801 Commissioners Road East, London, Ontario, Canada.
Age Ageing. 2012 May;41(3):299-308. doi: 10.1093/ageing/afs012. Epub 2012 Feb 27.
cognitive impairment is an established fall risk factor; however, it is unclear whether a disease-specific diagnosis (i.e. dementia), measures of global cognition or impairments in specific cognitive domains (i.e. executive function) have the greatest association with fall risk. Our objective was to evaluate the epidemiological evidence linking cognitive impairment and fall risk.
studies were identified through systematic searches of the electronic databases of MEDLINE, EMBASE, PyschINFO (1988-2009). Bibliographies of retrieved articles were also searched. A fixed-effects meta-analysis was performed using an inverse-variance method.
twenty-seven studies met the inclusion criteria. Impairment on global measures of cognition was associated with any fall, serious injuries (summary estimate of OR = 2.13 (1.56, 2.90)) and distal radius fractures in community-dwelling older adults. Executive function impairment, even subtle deficits in healthy community-dwelling older adults, was associated with an increased risk for any fall (summary estimate of OR = 1.44 (1.20, 1.73)) and falls with serious injury. A diagnosis of dementia, without specification of dementia subtype or disease severity, was associated with risk for any fall but not serious fall injury in institution-dwelling older adults.
the method used to define cognitive impairment and the type of fall outcome are both important when quantifying risk. There is strong evidence global measures of cognition are associated with serious fall-related injury, though there is no consensus on threshold values. Executive function was also associated with increased risk, which supports its inclusion in fall risk assessment especially when global measures are within normal limits.
认知障碍是公认的跌倒风险因素；然而，目前尚不清楚特定疾病诊断（即痴呆）、整体认知水平测量，还是特定认知领域（即执行功能）的损伤与跌倒风险的关联度最大。我们的目的是评估认知障碍与跌倒风险之间的流行病学证据。
通过对 MEDLINE、EMBASE、PyschINFO（1988-2009）电子数据库进行系统检索，确定研究对象。同时还检索了检索到的文章的参考文献。使用逆方差法进行固定效应荟萃分析。
27 项研究符合纳入标准。整体认知水平的损伤与任何跌倒、严重伤害（OR 的汇总估计值为 2.13（1.56，2.90））和社区居住的老年人桡骨远端骨折相关。即使是健康的社区居住老年人存在细微的执行功能损伤，也与任何跌倒（OR 的汇总估计值为 1.44（1.20，1.73））和跌倒致严重伤害的风险增加相关。痴呆的诊断，无论痴呆亚型或疾病严重程度如何，都与机构居住的老年人跌倒风险相关，但与严重跌倒损伤无关。
在量化风险时，定义认知障碍的方法和跌倒结局的类型都很重要。有强有力的证据表明整体认知水平与严重跌倒相关损伤相关，尽管目前还没有关于阈值的共识。执行功能也与风险增加相关，这支持其纳入跌倒风险评估，特别是在整体测量值处于正常范围内时。
