Older people with early, asymptomatic Alzheimer's at risk of falls
Even without cognitive problems, those with Alzheimer's-related brain
damage at increased risk of falls

Date:
September 15, 2020
Source:
Washington University School of Medicine
Summary:
Older people without cognitive problems who experience a fall may
have undetected neurodegeneration in their brains that puts them
at high risk of developing Alzheimer's dementia, according to a
new study.



FULL STORY ========================================================================== Falls are the leading cause of fatal injuries in older adults, causing
more than 800,000 hospitalizations and about 30,000 deaths in the
U.S. every year.

Some risk factors are well-known -- advanced age, problems with vision
or balance, muscle weakness -- but an under-recognized factor is early Alzheimer's disease. Older people in the earliest stages of Alzheimer's,
before cognitive problems arise, are more likely to suffer a fall than
people who are not on track to develop dementia.


========================================================================== Researchers at Washington University School of Medicine in St. Louis have
found that, in older people without cognitive problems who experience a
fall, the process of neurodegeneration that leads to Alzheimer's dementia already may have begun. The findings, available online in the Journal of Alzheimer's Disease, suggest that older people who have experienced falls should be screened for Alzheimer's and that new strategies may be needed
to reduce the risk of falling for people in the disease's early stages.

"In the world of fall research, we generally say that you're at risk of
falling if you lose strength and balance," said co-senior author Susan
Stark, PhD, an associate professor of occupational therapy, of neurology
and of social work.

"If you lose strength and balance, the recommended treatment is to work
on strength and balance. But if someone is falling for another reason,
maybe because his or her brain has begun accumulating Alzheimer's-related damage, that person might need a different treatment entirely. We
don't yet know what that treatment might be, but we hope we can use this information to come up with new treatment recommendations that will reduce
the risk of falls in this population." In 1987, John C. Morris, MD,
then a trainee at Washington University, discovered that older people
with Alzheimer's dementia are more than twice as likely to suffer a
traumatic fall than people of the same age without dementia.

Morris is now the Harvey A. and Dorismae Hacker Friedman Distinguished Professor of Neurology and head of the university's Charles F. and Joanne Knight Alzheimer's Disease Research Center.

Since Morris' discovery more than three decades ago, scientists have
learned that the brains of Alzheimer's patients start undergoing changes decades before memory loss and confusion become apparent. First, plaques
of amyloid proteins form, then tangles of tau protein. Some brain areas
begin to shrink, and communication networks between distant parts of
the brain start to decay. Stark and colleagues have shown that the link
between Alzheimer's and falling holds true even during the silent phase
of the disease: People with so-called preclinical Alzheimer's are at
increased risk of falling despite having no apparent cognitive problems.

To better understand why people without cognitive symptoms are at risk of falling, first author Audrey Kelemen, a graduate student in Stark's lab,
and colleagues followed 83 people over age 65 for a year. All participants
were assessed as cognitively normal by a qualified neurologist at the
beginning of the study. Each participant filled out monthly calendars
recording any falls and underwent brain scans for amyloid and for signs
of atrophy and impaired connectivity.

The researchers discovered that the presence of amyloid in the brain alone
did not put people at increased risk of falling but that neurodegeneration
did.

Participants who fell had smaller hippocampi -- brain regions that
are devoted to memory and that shrink in Alzheimer's disease. Their
somatomotor networks - - webs of connections that are involved in
receiving sensory inputs and controlling movement -- also showed signs
of decay. The researchers concluded that falling is most likely to occur
in the neurodegeneration phase of preclinical Alzheimer's -- the last
five years or so before memory loss and confusion arise.

"Since I started working on this project, I've started asking my patients
about falls, and I can't tell you how often that has helped me start understanding what is going on with the individual," said co-senior author
Beau M. Ances, MD, PhD, the Daniel J. Brennan, MD, Professor of Neurology
and a professor of radiology and of biomedical engineering. Ances treats patients who have dementia and other neurological conditions on the
Washington University Medical Campus.

"When a person's mobility is being diminished, even though the person
looks very normal, that could be a sign that something needs further evaluation," Ances said. "It's actually a really important potential
marker that should make us say, 'Wait a minute. Let's dive into this
more. Are there other things that go along with it?'" The researchers
have begun further experiments to better understand why brain changes in Alzheimer's put people at risk of falling, so they can develop fall-
prevention recommendations. In the meantime, simple changes could
go a long way toward protecting older people from devastating falls,
Stark said.

"You can prevent a lot of falls just by making the environment safer,"
Stark said. "Simple changes could help and can't hurt: making sure the
tub isn't slippery; making sure you can get up easily off the toilet;
balance and strength training; reviewing your prescriptions to see if
certain medications or combinations of medications are increasing the
risk of falling. Until we have specific fall-prevention treatments for
people with preclinical Alzheimer's, there are still plenty of things
we can do to make people safer."

========================================================================== Story Source: Materials provided by
Washington_University_School_of_Medicine. Original written by Tamara
Bhandari. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Audrey Keleman, Julie K. Wisch, Rebecca M. Bollinger, Elizabeth
A. Grant,
Tammie L. Benzinger, John C. Morris, Beau M. Ances, Susan
L. Stark. Falls Associate with Neurodegenerative Changes in ATN
Framework of Alzheimer's Disease. Journal of Alzheimer's Disease,
2020; 1 DOI: 10.3233/JAD-200192 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/09/200915140133.htm

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