Risk of Falls in Alzheimer’s Disease: A Prospective Study

• Published in: Internal Medicine Vol. 44; no. 7; pp. 717 - 721
• Main Authors: HORIKAWA, Etsuo, MATSUI, Toshifumi, ARAI, Hiroyuki, SEKI, Takashi, IWASAKI, Koh, SASAKI, Hidetada
• Format: Journal Article
• Language: English
• Published: Tokyo The Japanese Society of Internal Medicine 01.07.2005; Japanese Society of Internal Medicine
• Subjects: Accidental Falls - prevention & control; Accidental Falls - statistics & numerical data; Aged; Aged, 80 and over; Alzheimer Disease - complications; Alzheimer Disease - epidemiology; Alzheimer’s disease; Antipsychotic Agents - therapeutic use; Biological and medical sciences; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; falls; Female; General aspects; Humans; Magnetic Resonance Imaging; Male; Medical sciences; neuroleptics; Neurology; Prospective Studies; Quality of Life; silent brain infarctions; white matter lesions; Nervous system diseases; Infarct; Internal medicine; silent brain infarctions; Alzheimer disease; Neuroleptic; Risk; White matter; Cerebral disorder; Prospective; falls; neuroleptics; Central nervous system disease; Risk factor; Degenerative disease; Fall; white matter lesions; Lesion; Alzheimer's disease
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.44.717

Objective Falls are common in patients with Alzheimer’s disease (AD). Identification of the potential risk factors and developing preventive strategies for falls will have a significant impact in maintaining the quality of life in AD. Patients Clinical follow-up of 124 (74.1±6.1 years, range 62-88) mild to moderate AD patients in an outpatient memory clinic. Methods Postural sway, cognitive function, use of neuroleptics, severity of periventricular and deep white matter lesions, and the presence or absence of silent brain infarctions on magnetic resonance imaging were assessed at baseline. Results A total of 104 patients (84%) completed the study. Fall events were confirmed in 42.3% (44/104). After adjustment for age, gender, and cognitive status, a high grade of periventricular white matter lesions (odds ratio 8.7 [95%CI 1.5 to 51.8], p=0.017) and neuroleptic drug use (odds ratio 3.5 [95%CI 1.2 to 10.5], p=0.027) were significantly associated with an increased risk of falls. Conclusion Our results suggest that periventricular white matter lesions and the use of neuroleptics may be related to falls in mild to moderate AD. A comprehensive risk management of brain ischemia as well as the use of the smallest efficacious dose of neuroleptics in the treatment of behavioral and psychiatric symptoms of AD should be recommended to help reduce the risk of unexpected falls.