Accuracy of mobility tests for screening the risk of falls in patients with mild cognitive impairment and alzheimer’s disease

Ansai, Juliana Hotta; Vassimon-Barroso, Verena; Farche, Ana Claudia Silva; Buto, Marcele Stephanie de Souza; Andrade, Larissa Pires de; Rebelatto, José Rubens

doi:10.1590/1809-2950/18006726032019

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ORIGINAL RESEARCH • Fisioter. Pesqui. 26 (3) • Jul-Sep 2019 • https://doi.org/10.1590/1809-2950/18006726032019 copy

Accuracy of mobility tests for screening the risk of falls in patients with mild cognitive impairment and alzheimer’s disease

Acurácia de testes de mobilidade para o rastreio do risco de quedas no comprometimento cognitivo leve e doença de Alzheimer

Exactitud de las pruebas de movilidad para detectar riesgo de caídas en el deterioro cognitivo leve y en la enfermedad de Alzheimer

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Identifying gait and balance disorders in the earlier stages of Alzheimer’s disease (AD) and Mild Cognitive Impairment (MCI) could reduce or prevent falls in older adults. This cross-sectional study aimed to determine which mobility tests best discriminate the risk of falls in MCI and mild AD. Functional mobility was assessed by the timed up and go test (TUG) and 10-meter walk test (10MWT). A calendar of falls was produced, with follow-up via telephone calls during 6 months. For the MCI Group (n=38), time spent on the 10MWT was the best variable for discriminating fallers, with a cut-off point of 10.69 seconds associated with the highest accuracy (76.3%). In the AD Group (n=37), 10MWT cadence was the best variable for discriminating fallers, with a cut-off point of 101.39 steps per minute associated with an accuracy of 81.1%. As a conclusion, 10MWT time and cadence were the most accurate variables for screening the risk of falls in MCI and mild AD, respectively. The 10MWT is a functional, simple and easy test and it should be widely used in clinical practice.

Keywords |
Falls; Cognition; Aged

Characteristics, M (SD)	MCI Group		P-value	AD Group		P-value
	Fallers	Non-fallers		Fallers	Non-fallers
	(n=20)	(n=18)		(n=19)	(n=18)
Age (years)	77.3 (6.2)	74.1 (6.5)	0.140	78.1 (6.1)	77.0 (6.2)	0.592
Female sex, n (%)	16 (80.0)	16 (88.9)	0.453	10 (52.6)	11 (61.1)	0.603
Body mass index (kg/m²)	28.6 (3.9)	30.6 (4.4)	0.155	27.6 (5.5)	27.2 (5.4)	0.828
Educational level (years)	4.5 (4.3)	5.7 (3.6)	0.337	5.8 (4.5)	5.2 (4.8)	0.715
Number of comorbidities	2.5 (1.2)	3.3 (1.5)	0.083	3.1 (1.3)	3.6 (1.0)	0.190
Number of medication use	5.1 (2.8)	5.2 (3.8)	0.912	5.9 (4.1)	4.5 (1.9)	0.207
Psychotropic use, n (%)	8 (40.0)	6 (33.3)	0.671	17 (89.5)	12 (66.7)	0.092
Previous falls, n (%)	16 (80.0)**	6 (33.3)	0.004	12 (63.2)	9 (50.0)	0.419
Minnesota questionnaire	1200.0 (1694.2)	1863.3 (2415.5)	0.330	638.3 (834.4)	788.4 (1052.4)	0.633

Variable, M (SD)		MCI Group		P-value	AD Group		P-value
		Fallers	Non-fallers (n=18)		Fallers	Non-fallers (n=18)
		(n=20)	Non-fallers (n=18)		(n=19)	Non-fallers (n=18)
TUG
	Time (seconds)	16.0 (5.5)*	12.5 (2.2)	0.018	15.0 (4.5)	18.2 (5.1)	0.057
	Number of steps	20.3 (6.1)	17.1 (3.5)	0.059	18.5 (4.9)	21.2 (6.5)	0.175
	Cadence (steps/min)	77.2 (8.5)	81.9 (10.1)	0.131	74.8 (9.1)	69.6 (8.0)	0.076
10MWT
	Time (seconds)	13.6 (4.7)**	10.2 (1.7)	0.007	11.2 (3.1)*	13.6 (2.9)	0.021
	Number of steps	22.3 (6.6)*	18.5 (3.9)	0.045	19.3 (3.9)	21.7 (4.5)	0.095
	Cadence (steps/min)	99.9 (12.8)	108.6 (15.4)	0.065	105.1 (12.7)**	95.4 (5.5)	0.005

Groups	Variable		AUC (95% CI)	P-value	Cut-off point	Sensibility	Specificity	Accuracy	Positive Likelihood ratio	Relative risk (95% CI)
MCI: Fallers vs. non-fallers	TUG
		Time	0.70	0.039	≥13.78	65.0%	72.2%	68.4%	2.34	2.06
		Time	(0.53-0.86)	0.039	≥13.78	65.0%	72.2%	68.4%	2.34	(1.06-4.00)
		Steps	-	0.072	-	-	-	-	-	-
		Cadence	-	0.161	-	-	-	-	-	-
	10MWT
		Time	0.77	0.005	≥10.69	80.0%	72.2%	76.3%	2.88	3.24
		Time	(0.61-0.93)	0.005	≥10.69	80.0%	72.2%	76.3%	2.88	(1.33-7.88)
		Steps	0.71	0.029	≥18.50	70.0%	61.1%	65.8%	1.80	1.89
		Steps	(0.54-0.87)	0.029	≥18.50	70.0%	61.1%	65.8%	1.80	(0.93-3.85)
		Cadence	-	0.054	-	-	-	-	-	-
AD: fallers vs. non-fallers	TUG
		Time	0,70	0,036	≤17,56	78,90%	61,10%	70,20%	2,03	2,56
		Time	(0,53-0,87)	0,036	≤17,56	78,90%	61,10%	70,20%	2,03	(1,05-6,20)
		Steps	-	0,202	-	-	-	-	-	-
		Cadence	-	0,06	-	-	-	-	-	-
	10MWT
		Time	0,75	0,009	≤12,31	78,90%	66,70%	72,90%	2,37	2,86
		Time	(0,59-0,91)	0,009	≤12,31	78,90%	66,70%	72,90%	2,37	(1,17-6,96)
		Steps	-	0,098	-	-	-	-	-	-
		Cadence	0,79	0,003	≥101,39	73,70%	88,90%	81,10%	6,64	3,67
		Cadence	(0,62-0,95)	0,003	≥101,39	73,70%	88,90%	81,10%	6,64	(1,67-8,07)

	MCI			AD
	Falls-Yes	Falls-No		Falls-Yes	Falls-No
TUG			TUG
≥13.78 seconds	13	5	≤17.56 seconds	15	7
<13.78 seconds	7	13	>17.56 seconds	4	11
10MWT			10MWT
≥10.69 seconds	16	5	≤12.31 seconds	15	6
<10.69 seconds	4	13	>12.31 seconds	4	12
≥18.50 steps	14	7	≥101.3 steps/min	14	2
<18.50 steps	6	11	<101.3 steps/min	5	16

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[1] Corresponding address: Juliana Hotta Ansai - Avenida Costa e Silva - Campo Grande (MS), Brazil - Zip Code: 79070-900 - E-mail: julianaansai@gmail.com