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Falls and cognitive decline in Mexican Americans 75 years and older

Authors Padubidri A, Al Snih S, Samper-Ternent R, Markides KS, Ottenbacher KJ, Raji MA

Received 19 December 2013

Accepted for publication 14 February 2014

Published 22 April 2014 Volume 2014:9 Pages 719—726

DOI https://doi.org/10.2147/CIA.S59448

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 5

Anokha Padubidri,1,2 Soham Al Snih,2,3 Rafael Samper-Ternent,2,4 Kyriakos S Markides,2,5 Kenneth J Ottenbacher,2,3 Mukaila A Raji2,6

1
College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA; 2Sealy Center on Aging, 3Division of Rehabilitation Sciences, School of Health Professions, the University of Texas Medical Branch, Galveston, TX, USA; 4Department of Internal Medicine, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Columbia; 5Department of Preventive Medicine and Community Health, 6Department of Internal Medicine, the University of Texas Medical Branch, Galveston, TX, USA

Background: Little is known about long-term emotional and cognitive consequences of falls. We examined the association between falls and subsequent cognitive decline, and tested the hypothesis that depression would mediate any falls–cognition association among cognitively intact Hispanic Elders.
Methods: We used data from the Hispanic Established Population for the Epidemiological Study of the Elderly to examine change in Mini Mental State Examination (MMSE) scores over
the 6-year period according to number of falls. All participants (N=1,119) had MMSE scores ≥21 and complete data on Center for Epidemiologic Studies of Depression Scale, social and demographic factors, medical conditions (diabetes, heart attack, stroke, and hypertension), and hand grip muscle strength.
Results: At baseline, participants’ mean age was 80.8 years (range, 74–109), mean ­education was 6.3 years (range, 0–17), and mean MMSE was 25.2 (range, 21–30). Of the 1,119 ­participants, 15.8% experienced one fall and 14.4% had two or more falls. In mixed model analyses, having two or more falls was associated with greater decline in MMSE score (estimate =–0.81, standard error =0.19, P<0.0001) compared to having no fall, after adjusting for age, sex, marital status, and education. The magnitude of the association decreased (estimate =–0.65, standard error =0.19, P=0.0007) when adjustment was made for high depressive symptoms, suggesting a possible mediating effect of depression on the falls–cognition association. Female sex, high level of education, and high performance in hand grip muscle strength were associated with a slower decline in MMSE scores.
Conclusion: Having two or more falls was independently associated with steeper decline in cognition over 6 years, with a possible mediating effect of depression on the falls–cognition association.


Keywords: cognition, depression, elderly

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