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Does cognitive performance explain the gap between physiological and perceived fall-risk in people with multiple

Tobia Zanotto1, Danya Pradeep Kumar2, Daniel Golan3

  • 1Department of Occupational Therapy Education, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA; Mobility Core, University of Kansas Centre for Community Access, Rehabilitation Research, Education and Service, Kansas City, KS, USA; Landon Center on Aging, University of Kansas Medical Center, Kansas City, KS, USA.

Multiple Sclerosis and Related Disorders
|February 9, 2025
PubMed
Summary

Cognitive performance does not explain the mismatch between how people with multiple sclerosis (pwMS) physically function and their perceived fall risk. Nearly 30% of pwMS showed this discordance, but cognitive scores were similar across groups.

Keywords:
Accidental fallsCognitive dysfunctionMultiple sclerosisRehabilitation

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Area of Science:

  • Neurology
  • Neuroscience
  • Rehabilitation Medicine

Background:

  • Cognitive impairment is a known risk factor for falls in people with multiple sclerosis (pwMS).
  • The relationship between cognitive function and the discrepancy between physiological fall risk and perceived fall risk in pwMS remains unclear.
  • Understanding this relationship is crucial for fall prevention strategies in pwMS.

Purpose of the Study:

  • To investigate the association between cognitive performance and the concordance/discordance of physiological and perceived fall risk in pwMS.
  • To determine if cognitive deficits contribute to the mismatch between actual fall risk and an individual's awareness of their fall risk.
  • To explore cognitive domain performance in relation to different categories of fall risk perception.

Main Methods:

  • A cross-sectional analysis was conducted on 201 pwMS.
  • Physiological fall risk was assessed using gait speed, and perceived fall risk was measured by the Modified Falls Efficacy Scale.
  • Participants were classified into four groups based on physiological and perceived fall risk: high/high, high/low, low/low, and low/high.
  • Cognitive performance was evaluated using the NeuroTrax computerized cognitive battery, yielding a global cognitive score (GCS) and domain-specific scores.

Main Results:

  • Approximately 27.4% of pwMS demonstrated a discordance between their physiological and perceived fall risk.
  • No significant differences in global cognitive scores (GCS) or individual cognitive domain scores were found between individuals with discordant fall risk and those with concordant fall risk.
  • Among participants with concordant fall risk, those in the high physiological-high perceived fall risk group exhibited poorer cognitive performance (GCS) compared to the low physiological-low perceived fall risk group.

Conclusions:

  • A notable proportion of pwMS (approximately one in four) experience a discrepancy between their objective physical fall risk and their subjective perception of fall risk.
  • Cognitive performance, as measured by the NeuroTrax battery, does not appear to be the explanatory factor for this observed discordance in fall risk perception among pwMS.
  • Further research may be needed to identify other factors contributing to the misalignment between physiological and perceived fall risk in this population.