This longitudinal cohort study investigates cognitively normal participants with and without preclinical Alzheimer disease (AD) in order to examine: (1) the relationship between falls and functional mobility in preclinical stages of AD; and (2) a hypothesized model of central and peripheral mechanism(s) underlying falls and functional mobility in preclinical stages of AD.
Alzheimer disease (AD) is a slowly progressive neurodegenerative disease. Conversion to symptomatic AD occurs slowly over years through a series of preclinical stages marked by changes in molecular biomarkers. It is unknown whether functional mobility and falls are preclinical markers of AD. This longitudinal clinical study evaluates a cohort of cognitively normal individuals who are currently undergoing comprehensive clinical, neuropsychological, and biomarker evaluations at the Knight Alzheimer's Disease Research Center (Knight ADRC). They receive an annual in-home evaluation of fall risks and functional mobility and prospective ascertainment of falls. Comparisons of assessments of functional mobility will be performed with regard to measures of brain pathology (i.e., amyloidosis, tau, and neurodegeneration) to allow researchers to characterize when changes in falls and functional mobility occur during preclinical stages of AD. This study also examines the central and peripheral system mechanism(s) underlying falls and functional mobility in preclinical AD using structural equation modeling.
Study Type
OBSERVATIONAL
Enrollment
355
Washington University School of Medicine
St Louis, Missouri, United States
Number and Severity of Falls
Prospective monthly fall reporting will be collected using an automated phone/email system. Severity of falls will be calculated using a previously published algorithm.
Time frame: Cumulative falls at 4 years post-enrollment
Change from baseline: Dynamic balance and mobility
Dynamic balance and mobility will be assessed using the Performance Oriented Mobility Assessment (POMA), a task-oriented assessment.
Time frame: 4 years post-enrollment
Change from baseline: Gait Speed
Gait speed will be collected using the Timed Up and Go (TUG) test.
Time frame: 4 years post-enrollment
Change from baseline: Dual-task gait
Dual-task gait will be collected using the Timed Up and Go Cognitive (TUGcog) and Timed Up and Go Manual (TUGman)
Time frame: 4 years post-enrollment
Fall Risk Composite Score
A fall risk composite score will be calculated using established cut-off values, dichotomized as 0 (no risk), or 1 (fall risk), and summed. Higher score indicate higher fall risk. Constructs that will be included are: vision, alcohol abuse, urinary incontinence, depression, pain, medication, functional capacity with activities of daily living, previous falls, home hazards, and self-efficacy.
Time frame: 4 years post-enrollment
Change from baseline: Standing balance and vestibular function
Center of pressure path will be measured using Balance Tracking System (BTrackS)
Time frame: 4 years post-enrollment
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Change from baseline: Lower extremity strength
Lower extremity strength will be assessed using the 30-Second Chair Stand test and minimal change in the peak torque value
Time frame: 4 years post-enrollment
Change from baseline: Grip strength
Pounds of force will be measured using a handheld dynamometer
Time frame: 4 years post-enrollment
Change from baseline: Vision
Visual acuity will be collected using the Early Treatment Diabetic Retinopathy Study (ETDRS) test, and contrast sensitivity will be measured using the Pelli-Robson test
Time frame: 4 years post-enrollment
Change from baseline: Sensation
8-item questionnaire and sensation testing (vibration \[feet\] and sharp \[arms and legs\])
Time frame: 4 years post-enrollment
Change from baseline: Depression
Frequency of symptoms will be assessed using The Patient Health Questionnaire (PHQ-9) and Geriatric Depression Scale (GDS)
Time frame: 4 years post-enrollment
Change in baseline: Functional performance
Independence, safety, and adequacy with shopping, checkbook balancing, and medication management will be assessed using the Performance Assessment of Self-Care Skills (PASS)
Time frame: 4 years post-enrollment
Change from baseline: Falls behavior
Behaviors to prevent falls will be measured using the Falls Behavioral Scale for Older People (FaB)
Time frame: 4 years post-enrollment
Change from baseline: Olfaction
Olfaction will be assessed using the University of Pennsylvania Smell Identification Test (UPSIT)
Time frame: 2 years post-enrollment
Change from baseline: Hearing
Hearing impairment will be assessed using The Hearing Handicap Inventory for the Elderly (HHIE-S)
Time frame: 4 years post-enrollment