Assessment of Fall Risk, Reaction Time, Orientation, and Lower Extremity Strength in Dementia Patients: A Correlation Analysis

İlkem Güzel; Filiz Can

Klinik Araştırma

Demans Hastalarında Düşme Riski, Reaksiyon Süresi, Uzamsal Oryantasyon ve Alt Ekstremite Gücünün Değerlendirilmesi: Bir Korelasyon Analizi

Yıl 2023, Cilt: 4 Sayı: 2, 31 - 35, 13.09.2023

İlkem Güzel Filiz Can

Öz

Giriş: Demans, bilişsel gerilemeye ve işlevsel bozulmaya yol açan önemli bir sorun teşkil etmektedir. Kritik endişeler arasında, demans hastalarında artan düşme riski, yaşam kalitesinin düşmesine ve sağlık maliyetlerinin artmasına yol açmaktadır. Bu çalışma, bilişsel ve fiziksel faktörlerin etkileşimini tanıyarak, demans hastalarında düşme riski, reaksiyon süresi, uzamsal yönelim ve alt ekstremite kuvveti arasındaki ilişkiyi değerlendirmeyi amaçladı.

Gereç ve Yöntemler: Hafif ve orta şiddette demansı olan 30 katılımcı Ankara, Türkiye'deki huzurevlerinden seçildi. John Hopkins Düşme Riski Değerlendirme Aracı (JHFRAT), düşme riskini kategorilere ayırdı. Katılımcılara uzaysal oryantasyon, reaksiyon süresi ve alt ekstremite kuvvetini değerlendirmek için testler uygulandı. Bu faktörler arasındaki ilişkileri incelemek için korelasyon analizleri yapılmıştır.

Bulgular: JHFRAT skorları ile reaksiyon süresi (pozitif korelasyon), uzaysal oryantasyon (negatif korelasyon) ve alt ekstremite kuvveti (negatif korelasyon) arasında anlamlı ilişkiler bulundu. Bu bulgular, demans hastalarında hem bilişsel bozuklukları hem de fiziksel sınırlamaları ele alan bütüncül düşme önleme stratejilerine olan ihtiyacı vurgulamaktadır.

Sonuç: Çalışma, demans hastalarında düşme riski ile bilişsel bozukluklar ve fiziksel faktörler arasındaki karmaşık ilişkinin altını çizmektedir. Düşme riskini etkili bir şekilde azaltmak ve demanslı bireylerin esenliğini artırmak için kapsamlı müdahaleler gereklidir. Bu ilişkileri doğrulamak ve demans hastalarında düşmeyi önlemek için özel müdahaleler geliştirmek için daha büyük ve çeşitli popülasyonlarla daha fazla araştırma yapılması önemlidir.

Anahtar Kelimeler

demans, düşme, reaksiyon süresi, uzamsal oryantasyon, kas gücü

Kaynakça

1. Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc. 2018;66(4):693– 698. https://doi.org/10.1111/jgs.15304
2. Härlein J, Dassen T, Halfens RJ, Heinze C. Fall risk factors in older people with dementia or cognitive impairment: a systematic review. J Adv Nurs. 2009;65(5):922–933. https://doi.org/10.1111/j.1365-2648.2008.04950.x
3. Zhang W, Low L-F, Schwenk M, Mills N, Gwynn JD, Clemson L. Review of gait, cognition, and fall risks with implications for fall prevention in older adults with dementia. Dement Geriatr Cogn Disord. 2019;48(1-2):17–29. https://doi.org/10.1159/000504340
4. Chen T, Yoshida Y. Effects of power on balance and fall prevention in aging and older adults. Top Geriatr Rehabil. 2021;37(1):7–11. https://doi.org/10.1097/TGR.0000000000000296
5. Jiménez-García JD, Martínez-Amat A, Hita-Contreras F, Fábrega-Cuadros R, Álvarez-Salvago F, Aibar-Almazán A. Muscle strength and physical performance are associated with reaction time performance in older people. Int J Environ Res Public Health. 2021;18(11):5893. https://doi.org/10.3390/ijerph18115893
6. Schaat S, Koldrack P, Yordanova K, Kirste T, Teipel S. Real-time detection of spatial disorientation in persons with mild cognitive impairment and dementia. Gerontology. 2020;66(1):85–94. https://doi.org/10.1159/000500971
7. Marquardt G. Wayfinding for people with dementia: a review of the role of architectural design. HERD. 2011;4(2):75–90. https://doi.org/10.1177/193758671100400207
8. Taylor ME, Lord SR, Delbaere K, Kurrle SE, Mikolaizak AS, Close JC. Reaction time and postural sway modify the effect of executive function on risk of falls in older people with mild to moderate cognitive impairment. Am J Geriatr Psychiatry. 2017;25(4):397–406. https://doi.org/10.1016/j.jagp.2016.10.010
9. Chen Y-T, Hou C-J, Derek N, Huang S-B, Huang M-W, Wang Y-Y. Evaluation of the reaction time and accuracy rate in normal subjects, MCI, and dementia using serious games. Appl Sci. 2021;11(2):628. https://doi.org/10.3390/app11020628
10. Malak R, Kostiukow A, Krawczyk-Wasielewska A, Keczmer P, Mojs E, Glodowska K, et al. Dysfunctions associated with dementia and their treatment. Ann Agric Environ Med. 2014;21(4). https://doi. org/10.5604/12321966.1129934
11. Filardi M, Barone R, Bramato G, Nigro S, Tafuri B, Frisullo ME, et al. The relationship between muscle strength and cognitive performance across Alzheimer’s disease clinical continuum. Front Neurol. 2022;13:833087. https://doi.org/10.3389/fneur.2022.833087
12. Tian Q, Chastan N, Bair W-N, Resnick SM, Ferrucci L, Studenski SA. The brain map of gait variability in aging, cognitive impairment and dementia-a systematic review. Neurosci Biobehav Rev. 2017;74:149–62. https://doi. org/10.1016/j.neubiorev.2017.01.020
13. Özüdoğru A, Canlı M, Kuzu Ş, Aslan M, Ceylan İ, Alkan H. Muscle strength, balance and upper extremity function are not predictors of cervical proprioception in healthy young subjects. Somatosens Mot Res. 2023;40(2):78– 82. https://doi.org/10.1080/08990220.2023.2183832
14. Poe SS, Dawson PB, Cvach M, Burnett M, Kumble S, Lewis M, et al. The Johns Hopkins Fall Risk Assessment Tool. J Nurs Care Qual. 2018;33(1):10–19. https://doi.org/10.1097/NCQ.0000000000000301
15. Damoiseaux-Volman BA, van Schoor NM, Medlock S, Romijn JA, van der Velde N, Abu-Hanna A. External validation of the Johns Hopkins Fall Risk Assessment Tool in older Dutch hospitalized patients. Eur Geriatr Med. 2023;14(1):69–77. https://doi.org/10.1007/s41999-022-00719-0
16. Carroll C, Arnold LA, Eberlein B, Westenberger C, Colfer K, Naidech AM, et al. Comparison of two different models to predict fall risk in hospitalized patients. Jt Comm J Qual Patient Saf. 2022;48(1):33–39. https://doi. org/10.1016/j.jcjq.2021.09.009
17. Kozhevnikov M, Hegarty M. A dissociation between object manipulation spatial ability and spatial orientation ability. Mem Cognit. 2001;29:745–756.https://doi.org/10.3758/BF03200477
18. Deary IJ, Liewald D, Nissan J. A free, easy-to-use, computer-based simple and four-choice reaction time programme: the Deary-Liewald reaction time task. Behav Res Methods. 2011;43:258–268. https://doi.org/10.3758/s13428-010-0024-1
19. Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport. 1999;70(2):113–119. https://doi.org/10.1080/02701367.1999.10608028
20. Park H-J, Lee N-G, Kang T-W. Fall-related cognition, motor function, functional ability, and depression measures in older adults with dementia. NeuroRehabilitation. 2020;47(4):487–494. https://doi.org/10.3233/NRE- 203249
21. Okubo Y, Schoene D, Lord SR. Step training improves reaction time, gait and balance and reduces falls in older people: a systematic review and metaanalysis. Br J Sports Med. 2017;51(7):586–593. https://doi.org/10.1136/bjsports-2015-095452
22. Pijnappels M, Delbaere K, Sturnieks DL, Lord SR. The association between choice stepping reaction time and falls in older adults -a path analysis model. Age Ageing. 2010;39(1):99–104. https://doi.org/10.1093/ageing/afp200
23. Wade MG, Jones G. The role of vision and spatial orientation in the maintenance of posture. Phys Ther. 1997;77(6):619–628. https://doi.org/10.1093/ ptj/77.6.619 24. Cho KH, Bok SK, Kim Y-J, Hwang SL. Effect of lower limb strength on falls and balance of the elderly. Ann Rehabil Med. 2012;36(3):386–393. https://doi. org/10.5535/arm.2012.36.3.386

Assessment of Fall Risk, Reaction Time, Orientation, and Lower Extremity Strength in Dementia Patients: A Correlation Analysis

Yıl 2023, Cilt: 4 Sayı: 2, 31 - 35, 13.09.2023

İlkem Güzel Filiz Can

Öz

Introduction: Dementia poses a significant challenge, leading to cognitive decline and functional impairment. Among the critical concerns is the heightened fall risk in dementia patients, leading to diminished quality of life and increased healthcare costs. This study aimed to assess the relationship between fall risk, reaction time, spatial orientation, and lower extremity strength in dementia patients, recognizing the interplay of cognitive and physical factors.

Materials and Methods: Thirty participants with mild to moderate dementia were selected from nursing homes in Ankara, Turkey. The John Hopkins Fall Risk Assessment Tool (JHFRAT) categorized fall risk. Participants underwent tests to evaluate spatial orientation, reaction time, and lower extremity strength. The associations between these factors were investigated using correlation analysis.

Results: Significant associations were found between JHFRAT scores and reaction time (positive correlation), spatial orientation (negative correlation), and lower extremity strength (negative correlation). These findings highlight the need for holistic fall prevention strategies addressing both cognitive impairments and physical limitations in dementia patients.

Conclusion: The study underscores the complex relationship between fall risk and cognitive impairments as well as physical factors in dementia patients. Comprehensive interventions are necessary to effectively reduce fall risk, enhancing the well-being of individuals with dementia. Further research with larger and diverse populations is essential to confirm these relationships and develop tailored interventions for fall prevention in dementia patients.

Anahtar Kelimeler

dementia, falls, reaction time, spatial orientation, muscle strength

Kaynakça

1. Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc. 2018;66(4):693– 698. https://doi.org/10.1111/jgs.15304
2. Härlein J, Dassen T, Halfens RJ, Heinze C. Fall risk factors in older people with dementia or cognitive impairment: a systematic review. J Adv Nurs. 2009;65(5):922–933. https://doi.org/10.1111/j.1365-2648.2008.04950.x
3. Zhang W, Low L-F, Schwenk M, Mills N, Gwynn JD, Clemson L. Review of gait, cognition, and fall risks with implications for fall prevention in older adults with dementia. Dement Geriatr Cogn Disord. 2019;48(1-2):17–29. https://doi.org/10.1159/000504340
4. Chen T, Yoshida Y. Effects of power on balance and fall prevention in aging and older adults. Top Geriatr Rehabil. 2021;37(1):7–11. https://doi.org/10.1097/TGR.0000000000000296
5. Jiménez-García JD, Martínez-Amat A, Hita-Contreras F, Fábrega-Cuadros R, Álvarez-Salvago F, Aibar-Almazán A. Muscle strength and physical performance are associated with reaction time performance in older people. Int J Environ Res Public Health. 2021;18(11):5893. https://doi.org/10.3390/ijerph18115893
6. Schaat S, Koldrack P, Yordanova K, Kirste T, Teipel S. Real-time detection of spatial disorientation in persons with mild cognitive impairment and dementia. Gerontology. 2020;66(1):85–94. https://doi.org/10.1159/000500971
7. Marquardt G. Wayfinding for people with dementia: a review of the role of architectural design. HERD. 2011;4(2):75–90. https://doi.org/10.1177/193758671100400207
8. Taylor ME, Lord SR, Delbaere K, Kurrle SE, Mikolaizak AS, Close JC. Reaction time and postural sway modify the effect of executive function on risk of falls in older people with mild to moderate cognitive impairment. Am J Geriatr Psychiatry. 2017;25(4):397–406. https://doi.org/10.1016/j.jagp.2016.10.010
9. Chen Y-T, Hou C-J, Derek N, Huang S-B, Huang M-W, Wang Y-Y. Evaluation of the reaction time and accuracy rate in normal subjects, MCI, and dementia using serious games. Appl Sci. 2021;11(2):628. https://doi.org/10.3390/app11020628
10. Malak R, Kostiukow A, Krawczyk-Wasielewska A, Keczmer P, Mojs E, Glodowska K, et al. Dysfunctions associated with dementia and their treatment. Ann Agric Environ Med. 2014;21(4). https://doi. org/10.5604/12321966.1129934
11. Filardi M, Barone R, Bramato G, Nigro S, Tafuri B, Frisullo ME, et al. The relationship between muscle strength and cognitive performance across Alzheimer’s disease clinical continuum. Front Neurol. 2022;13:833087. https://doi.org/10.3389/fneur.2022.833087
12. Tian Q, Chastan N, Bair W-N, Resnick SM, Ferrucci L, Studenski SA. The brain map of gait variability in aging, cognitive impairment and dementia-a systematic review. Neurosci Biobehav Rev. 2017;74:149–62. https://doi. org/10.1016/j.neubiorev.2017.01.020
13. Özüdoğru A, Canlı M, Kuzu Ş, Aslan M, Ceylan İ, Alkan H. Muscle strength, balance and upper extremity function are not predictors of cervical proprioception in healthy young subjects. Somatosens Mot Res. 2023;40(2):78– 82. https://doi.org/10.1080/08990220.2023.2183832
14. Poe SS, Dawson PB, Cvach M, Burnett M, Kumble S, Lewis M, et al. The Johns Hopkins Fall Risk Assessment Tool. J Nurs Care Qual. 2018;33(1):10–19. https://doi.org/10.1097/NCQ.0000000000000301
15. Damoiseaux-Volman BA, van Schoor NM, Medlock S, Romijn JA, van der Velde N, Abu-Hanna A. External validation of the Johns Hopkins Fall Risk Assessment Tool in older Dutch hospitalized patients. Eur Geriatr Med. 2023;14(1):69–77. https://doi.org/10.1007/s41999-022-00719-0
16. Carroll C, Arnold LA, Eberlein B, Westenberger C, Colfer K, Naidech AM, et al. Comparison of two different models to predict fall risk in hospitalized patients. Jt Comm J Qual Patient Saf. 2022;48(1):33–39. https://doi. org/10.1016/j.jcjq.2021.09.009
17. Kozhevnikov M, Hegarty M. A dissociation between object manipulation spatial ability and spatial orientation ability. Mem Cognit. 2001;29:745–756.https://doi.org/10.3758/BF03200477
18. Deary IJ, Liewald D, Nissan J. A free, easy-to-use, computer-based simple and four-choice reaction time programme: the Deary-Liewald reaction time task. Behav Res Methods. 2011;43:258–268. https://doi.org/10.3758/s13428-010-0024-1
19. Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport. 1999;70(2):113–119. https://doi.org/10.1080/02701367.1999.10608028
20. Park H-J, Lee N-G, Kang T-W. Fall-related cognition, motor function, functional ability, and depression measures in older adults with dementia. NeuroRehabilitation. 2020;47(4):487–494. https://doi.org/10.3233/NRE- 203249
21. Okubo Y, Schoene D, Lord SR. Step training improves reaction time, gait and balance and reduces falls in older people: a systematic review and metaanalysis. Br J Sports Med. 2017;51(7):586–593. https://doi.org/10.1136/bjsports-2015-095452
22. Pijnappels M, Delbaere K, Sturnieks DL, Lord SR. The association between choice stepping reaction time and falls in older adults -a path analysis model. Age Ageing. 2010;39(1):99–104. https://doi.org/10.1093/ageing/afp200
23. Wade MG, Jones G. The role of vision and spatial orientation in the maintenance of posture. Phys Ther. 1997;77(6):619–628. https://doi.org/10.1093/ ptj/77.6.619 24. Cho KH, Bok SK, Kim Y-J, Hwang SL. Effect of lower limb strength on falls and balance of the elderly. Ann Rehabil Med. 2012;36(3):386–393. https://doi. org/10.5535/arm.2012.36.3.386

Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	İngilizce
Konular	Geriatri ve Gerontoloji, Nöroloji ve Nöromüsküler Hastalıklar, Fizyoterapi
Bölüm	Araştırma makalesi
Yazarlar	İlkem Güzel 0000-0001-9994-0120 Filiz Can 0000-0003-0641-9956
Yayımlanma Tarihi	13 Eylül 2023
Gönderilme Tarihi	15 Ağustos 2023
Yayımlandığı Sayı	Yıl 2023 Cilt: 4 Sayı: 2

Kaynak Göster

AMA	Güzel İ, Can F. Assessment of Fall Risk, Reaction Time, Orientation, and Lower Extremity Strength in Dementia Patients: A Correlation Analysis. YIU Saglik Bil Derg. Eylül 2023;4(2):31-35.

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