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Falls predict faster progression to Alzheimer's dementia
Audrey A Keleman1,2,3, Melody Li4, Julie K Wisch4
1Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA.
Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|February 7, 2026
Summary
Falls in cognitively unimpaired older adults may signal faster Alzheimer's disease (AD) progression. Individuals with preclinical AD and falls progressed most rapidly to mild dementia.
Area of Science:
- Neuroscience
- Gerontology
- Neurology
Background:
- Preclinical Alzheimer's disease (AD) involves brain amyloid accumulation in cognitively normal individuals (Clinical Dementia Rating [CDR] = 0).
- Distinguishing healthy aging from preclinical AD is difficult due to overlapping age-related impairments like falls.
- Falls are common in older adults and can be an early indicator of neurological changes.
Purpose of the Study:
- To investigate the association between falls and cognitive decline in individuals with preclinical Alzheimer's disease.
- To determine if falls accelerate the progression from preclinical AD to mild dementia (CDR 1).
Main Methods:
- A longitudinal cohort study followed 125 cognitively unimpaired (CDR 0) older adults for a median of 10 years.
- Falls were monitored for 1 year, and preclinical AD status (amyloid) was assessed at baseline.
- Participants were categorized into four groups based on preclinical AD status and fall occurrence: Preclinical AD-Fall-, Preclinical AD-Fall+, Preclinical AD+Fall-, and Preclinical AD+Fall+.
- Survival analysis was used to compare time to progression to CDR 1 (mild dementia) across groups.
Main Results:
- The Preclinical AD+Fall+ group showed the most rapid progression to CDR 1.
- Individuals with no preclinical AD and no falls (Preclinical AD-Fall-) exhibited the slowest progression.
- Progression rates were similar for those with preclinical AD but no falls (Preclinical AD+Fall-) and those without preclinical AD but with falls (Preclinical AD-Fall+).
Conclusions:
- Falls may be an early indicator of accelerated Alzheimer's disease dementia progression.
- The association suggests that falls could reflect underlying motor and gait dysfunction related to AD pathology.
- Identifying fall risk in cognitively unimpaired individuals may aid in early detection of AD progression.
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