[Relationship between cognitive deficits, behavioral disturbances and falls in patients with dementia]

Prospective study was conducted in order to investigate the relationship between cognitive and behavioral disturbances and falls in dementia. Falls and fall-related fractures were studied in 154 ambulatory patients who were admitted to a geriatric intermediate nursing facility with a diagnosis of Alzheimer's type dementia (DAT) or mixed Alzheimer and vascular dementia (MIX). The Mini-Mental State (MMS) was used for the evaluation of cognitive status, and the Dementia Behavior Disturbance Scale (DBD) was used as a behavioral parameter. In order to evaluate problematic behavior in walking, a derivative scale (DBD-W) was developed from the DBD by choosing three items relevant to wandering. During the 3 months of observation, 61 patients fell more than once; 15 of them experienced fractures. The mean MMS scores were higher in non fallers, fallers who did not sustain fractures and those complicated with fractures, in that order, and the difference between the non fallers and fallers with fractures was statistically significant. When the subjects were divided into three subgroups on the basis of the MMS scores, there was a trend toward a higher ratio of fallers or those complicated with fractures in the subgroup with the lower MMS score. The DBD and DBD-W scores were not associated with falls or fractures, although fallers had a slightly higher DBD or DBD-W score than non fallers. These findings suggest that the risk of falling or fracture becomes higher with the advance of cognitive impairment in institutionalized ambulatory patients with DAT or MIX. The findings also suggest that behavioral disturbances are not necessarily associated with falls or fractures.