Discriminant ability of novel cognitive-motor assessments to distinguish between fallers and non-fallers – Preliminary findings

Abstract

Introduction

Falls are a major cause for injuries in older adults and are associated with motor and cognitive impairments (Hsu, 2012). Thus, sensitive assessment tools capturing subtle changes in motor and cognitive functioning are crucial for the prediction of falls. Aim of this study was to test the ability of a novel, instrumented, cognitive-motor assessment battery, to distinguish between older persons who experienced a fall in the past 12 months (fallers) and persons who did not (non-fallers) as well as its added value to predict fall status compared to gold-standard clinical fall risk assessments.

Methods

This is a secondary analysis using baseline data of an international randomized controlled trial. Participants (age > 60, categorized in two groups: fallers and non-fallers) performed five instrumented tests (Reaction time test (psychomotor speed), Flexibility test (mental flexibility), Go/No-Go task (inhibition), Sway test (postural control), and Coordinated Stability test (dynamic balance control), as well as the Timed-up and Go (TUG) test as a gold standard assessment. Binominal logistic regression analyses were conducted for each cognitive-motor assessment separately to identify test variables significantly associated with group assignment which could then be included in a further logistic regression model. Furthermore, a Receiver Operating Characteristic (ROC) analysis was performed.

Results

Preliminary results of n = 38 showed among the instrumented assessments only inhibition (p = .016) and dynamic balance control (p = .014) were significantly associated with fall status and therefore included in the second regression model. In this second model, both functions contributed significantly in predicting fall status (inhibition: p = .040, dynamic balance control: p = .028). This regression model was statistically significant and resulted in a good amount of explained variance (χ²(2) = 14.283 (p = .001), R² = .418) with a sensitivity of 84.2% and a specificity of 73.7%. Similarly, the ROC analysis showed significant Area under the Curve (AUC) values only for inhibition (AUC = .751, p = .008) and dynamic balance control (AUC = .765, p = .005), whereas the AUC value of the TUG test remained non-significant (AUC = .681, p = .056).

Discussion/Conclusion

Based on this preliminary analysis, two tests of the novel instrumented cognitive-motor assessment battery assessing inhibition and dynamic balance control were able to distinguish between fallers and non-fallers and these tests showed better discriminative properties compared with the TUG. This supports the results of previous research which showed only limited discriminant validity of the TUG in terms of fall risk (Schoene et al., 2013). Therefore, the cognitive-motor assessments might provide an added value for clinical fall risk assessment. The study is still ongoing, and thus, the complete results (of N = 145) will be presented at the conference.

References

Hsu, C. L., Nagamatsu, L. S., Davis, J. C., & Liu-Ambrose, T. (2012). Examining the relationship between specific cognitive processes and falls risk in older adults: A systematic review. Osteoporosis International, 23, 2409-2424. https://doi.org/10.1007/s00198-012-1992-z

Schoene, D., Wu, S. M. S., Mikolaizak, A. S., Menant, J., Smith, S. T., & Delbaere, K. (2013). Discriminative ability and predictive validity of the timed up and go test in identifying older people who fall: Systematic review and meta-analysis. Journal of the American Geriatrics Society, 61, 202-208. https://doi.org/10.1111/jgs.12106