Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia,
Department of Occupational Therapy, Wolper Jewish Hospital, Sydney, New South Wales, Australia,
Dement Geriatr Cogn Disord. 2019;48(1-2):17-29. doi: 10.1159/000504340. Epub 2019 Nov 19.
Older people with cognitive impairment are at increased risk of falls; however, fall prevention strategies have limited success in this population. The aim of this paper is to review the literature to inform a theoretical framework for fall prevention in older adults with dementia.
A narrative review was conducted on fall risk factors in people with cognitive impairment, the relationship between cognition and gait, and their joint impact on the risk of falls. This was used to develop a theoretical framework for fall prevention for people with dementia. Executive function and motor function are closely related as they share neuroanatomy. This close relationship has been confirmed by observational studies including neuroimaging and intervention studies. Executive function is the cognitive domain most commonly associated with gait dysfunction. Attention, sensory integration, and motor planning are the sub-domains of executive function associated with risk of falls through gait dysfunction, whereas cognitive flexibility, judgement, and inhibitory control affect risk of falls through risk-taking behaviour. Key Messages: Gait, cognition, and falls are closely related. The comorbidity and interaction between gait abnormality and cognitive impairment may underpin the high prevalence of falls in older adults with dementia. Gait assessment and cognitive assessment, particularly executive function, should be integrated in fall risk screening. Assessment results should be interpreted and utilised using a multidisciplinary approach; specific strategies such as customised gait training and behavioural modulation should be considered as part of falls prevention for people with dementia.
认知障碍的老年人跌倒风险增加；然而，预防跌倒的策略在该人群中的效果有限。本文旨在回顾文献，为痴呆老年人的跌倒预防提供理论框架。
对认知障碍者的跌倒风险因素、认知与步态之间的关系及其对跌倒风险的共同影响进行了叙述性综述。这为痴呆症患者的跌倒预防提供了一个理论框架。执行功能和运动功能密切相关，因为它们共享神经解剖学。这一密切关系已通过包括神经影像学和干预研究在内的观察性研究得到证实。执行功能是与步态障碍最常相关的认知领域。注意力、感觉整合和运动规划是与步态障碍相关的跌倒风险的执行功能子领域，而认知灵活性、判断力和抑制控制则通过冒险行为影响跌倒风险。
步态、认知和跌倒密切相关。步态异常和认知障碍的并存和相互作用可能是痴呆症老年人跌倒高发的原因。应在跌倒风险筛查中整合步态评估和认知评估，特别是执行功能。评估结果应通过多学科方法进行解释和利用；应考虑特定策略，如定制步态训练和行为调节，作为痴呆症患者跌倒预防的一部分。
