Older people with asymptomatic Alzheimer disease (AD) have an increased risk of falls, according to a new study published in the Journal of Alzheimer’s Disease.

Falls in older adults cause 800,000 hospitalizations and 30,000 deaths in the United States every year, making them the leading cause of fatal injury in older adults. Advanced age, problems with vision or balance, and muscle weakness are all well-known risk factors. 

However, falls are an underrecognized factor in early AD. The connection was discovered in 1987 by John C. Morris, MD, a trainee at the time at Washington University. He found that older adults with AD were more than twice as likely to suffer a traumatic fall than people of the same age without dementia. 

The study included 83 people over the age of 65, all of whom were assessed as cognitively normal by a neurologist at the start of the study and followed for a year. The participants kept a monthly calendar of any falls they experienced and underwent brain scans for amyloid and for signs of atrophy and impaired connectivity.   

Investigators found that neurodegeneration put participants at an increased risk of falls, but amyloid in the brain alone did not. Participants with a smaller hippocampi—the brain region that helps in memory function and shrinks during AD—also were more likely to fall. 

The participants’ somatomotor networks also showed signs of decay in those who fell. Investigators concluded that falling was most likely to occur in the neurodegeneration phase of preclinical AD, which occurs in the last 5 years or so before the onset of memory loss and confusion. 

"You can prevent a lot of falls just by making the environment safer," Susan Stark, PhD, co-senior author and associate professor of occupational therapy, of neurology and of social work at Washington University School of Medicine, said in the press release. "Simple changes could help and can't hurt: making sure the tub isn't slippery; making sure you can get up easily off the toilet; balance and strength training; reviewing your prescriptions to see if certain medications or combinations of medications are increasing the risk of falling. Until we have specific fall-prevention treatments for people with preclinical Alzheimer's, there are still plenty of things we can do to make people safer."

Investigators have begun further experiments in order to understand why brain changes in patients with AD make them more prone to falling. In doing so, they hope to provide more detailed fall-prevention recommendations.

Reference:
Older people with early, asymptomatic Alzheimer's at risk of falls [News Release] September 14, 2020; St Louis, MO. https://new.eurekalert.org/pub_releases/2020-09/wuso-opw091420.php. Accessed September 23, 2020